PROCEDURE 42 • Understanding is needed of cardiovascular anatomy and physiology, principles of cardiac conduction, dysrhythmia interpretation, and electrical safety. • Advanced cardiac life support knowledge and skills are needed. • Clinical and technical competence in the use of the defibrillator is needed. • Knowledge of aseptic and sterile technique is necessary. • Knowledge of internal paddle placement and energy requirements for internal defibrillation is needed. • Emergent open sternotomy or thoracotomy precedes internal defibrillation (see Procedures 43 and 44). • Internal paddle placement should ensure that the axis of the heart is situated between the sources of current. • Energy requirements for internal defibrillation usually range from 5 to 20 J for biphasic shocks and 10 to 40 J for monophasic shocks.3,4 • Surgical head cover, mask, eye protection, sterile gown, sterile gloves • Open sternotomy or thoracotomy tray • Sterile internal paddles (ensure compatibility with the defibrillator) • Defibrillator with electrocardiogram (ECG) oscilloscope and recorder • Antiseptic solution (e.g., 2% chlorhexidine-based preparation) • Large sterile suction catheter, tubing, suction canisters, suction regulator, and suction source • Flow meter for oxygen administration • Bag-valve device with mask capable of delivering 100% oxygen and at least 500-mL volumes • Intravenous access and IV fluids (e.g., 500 mL of normal saline) Additional equipment as needed includes the following:
Defibrillation (Internal)
PREREQUISITE NURSING KNOWLEDGE
EQUIPMENT
42: Defibrillation (Internal)
Rationale: Internal defibrillation usually is performed in the face of sudden hemodynamic collapse.
