Using an AED on a patient with an ICD??

BelgianRN · Mar 26, 2012

Yes you can, you just have to place your pads alternatively if they happen to have placed the AICD around the right clavicle area. Possible positions could be: anterior/posterior directly above the heart (the pacing position), left clavicle right base position.

If they placed the AICD in the left clavicle area (most often in my experience) you can use the classic position of your pads safely.

But of course if you need an AED for your AICD patient there is obviously something wrong ^^.

A good tip: what I generally do when a patiënt has a port-a-cath, pacemaker or AICD I place a bandaid over it and mark it with a permanent marker: PAC, PM, AICD. So in the heat of battle people know to use alternative placement, or don't spend minutes getting vascular acces when there is a PAC available. Of course outside of the hospital that's not as practical :)

Sun0408, ASN, RN · Mar 26, 2012

Links were provided in your other post re this issue.

PEPPEPEPDad · Mar 26, 2012

In short- yes.

The ICD is surgically implanted into a person to deliver electricity to the heart when it detects it as fast- VF or VT (most new ones also recognise and interviene with other arrhythmias).

The AED is placed onto a person to identify VF or VT, and then give a shock.

Discussion- If the ICD is not doing its job, malfunctioning?, you should use the AED to keep the patient alive. I work in Australia and our current Advanced Life support guidelines suggest not putting the pads within 8cm of any implantable device (ie an ICD) as it may cause burns.

Not sure about the equiptment where you work, but we use a manual cardiac monitor/defib like a 'lifepak 15' (as apposed to an AED) to identify the rhythms ourselves to carry out defib, pacing, cardioversion.

Electrical Therapy for Adult Advanced Life Support

sarabellum1 · Mar 26, 2012

Ok thank you! My pt. was admitted to the ED for a v-tach storm and the ICD went nuts (20 shocks) so they gave lidocaine and amiodarone. I guess my question was more related to the thought of: when medic picks up the pt., do they use the AED or just transport and administer meds?

sapphire18 · Mar 26, 2012

Just wondering why you would have to use an external defibrillator if they have an internal one? They do the same thing.

ukstudent · Mar 26, 2012

Internal AICD's have a limited number of shocks that they can deliver, around 150-160 or so. During a v-tach storm they can go through the lifetime amount of shocks the device can deliver. You then end up externally shocking them. I have seen it happen just once.

Silverlight2010 · Mar 26, 2012

I've seen one where the settings really needed to be adjusted. Pt was having frequent runs of paroxysmal v-tach and the settings were such that he wasn't getting shocked. Scared the crap out of us that night! Runs so long and frequent it was pretty much his "normal" rhythm and he was completely asymptomatic! Hope I never see anything like it ever again!

BelgianRN · Mar 26, 2012

I've seen one where the settings really needed to be adjusted. Pt was having frequent runs of paroxysmal v-tach and the settings were such that he wasn't getting shocked. Scared the crap out of us that night! Runs so long and frequent it was pretty much his "normal" rhythm and he was completely asymptomatic! Hope I never see anything like it ever again!

Perhaps it was for the best the AICD didn't shock if he was asymptomatic. I've seen patients on numerous occasions cry and ask us to please make the shocking stop if the AICD started misfiring or firing on rhythms that remained hemodynamically stable.

Silverlight2010 · Mar 27, 2012

Perhaps it was for the best the AICD didn't shock if he was asymptomatic.

I agree!