[CANRN]

Recently we have had several patients with implantable defibrillators and we have had to de-activate them (at patient and family request, and also due to dying process). Have any of you had experience with this and if you have, do you have a policy in place?

[doodlemom]

Originally Posted by CANRN

Recently we have had several patients with implantable defibrillators and we have had to de-activate them (at patient and family request, and also due to dying process). Have any of you had experience with this and if you have, do you have a policy in place?

We have several magnets around our office that we got from the cardiologist's office that we just place on top of the pt (if the pt has not been able to go in to have it de-activated.)

[jerseyRN]

You do it yourself? Really? We call the cardiologist who sends a tech to the bedside with a machine to deactivate. They always want the nurse present at that time.... they ask the nurse to "push the button"!

[CANRN]

Originally Posted by jerseyRN

You do it yourself? Really? We call the cardiologist who sends a tech to the bedside with a machine to deactivate. They always want the nurse present at that time.... they ask the nurse to "push the button"!

We have deactivated two of the three we had this past couple of months. two were in the home. The first one, the nurse placed the magnet over the site and taped it to his chest for 30-45 mins and it deactivated. The second patient had a dual deb/pacer. I had to call the maker and found we needed to leave the magnet taped to his chest or it would reactivate. The third patient was in respite and the cardiologist did send in a tech to do the procedure. All these patient's were very close to actively dying.

Our manager said she is going to buy several magnets so we don't have to keep running to the ER to get theirs. A policy is being written at this time, there was not one in place and she was not aware of it. I was just curious if anyone else has had to do this. The hospital in our area (our mother company so to speak) is doing more and more cardiac procedures. We anticipate there being more of these situations in the future.

[burn out]

We keep a magnet on our refrigerator door to be used just for this purpose.
Like they already said we sit it or tape it over the pacer/defib. and about 30-45 minutes it stops. We then take it off and so far I have never seen one restart.

[andyg]

We have run up on this on many occassions. Ususally it has been our experience the "defibs" were placed due to other helath problems in the past and usually has nothing to do with their terminal dx. Once the DNR is in place we will usally start teaching the family concerning how these work and the possibility of "shocks" after the patient has expired and how this could injure someone else. We actually have taught the family on how to tape in place or we try to do prior to the patient actual death. Just an FYI we have contacts with the manufacturers rep and all we do is call and they will send us a box of magnets to use whenever we need them. This way there is no cost involved.

[jerseyRN]

I'm realizing how much I don't know about this topic...

does the magnet deactivate the pacer AND the defib?

We generally want to leave the pacer alone, but eliminate the possibility of the patient getting shocked as he/she dies (by turning off the defib).

[BeExcellent]

Does the SIZE of the magnet matter?

[burn out]

We have used them on pacer and dual demand I suppose it also deactivates the defib ...i never saw any spikes on the ekg afterwards. The magnet weighs about 1-2 pounds and is circular with a hole in the center. I don't know if you have to have a hole in it or not but I don't think so.w

[andyg]

There is the internal pacemaker which will keep the heart rate essentially "normal" but it usually does not "shock" and will not really affect the patient because of chemical changes within the body hen the patient is actively dying. The internal defib will and can "shock" the person just as if you were putting the external defibs on a patient to shcok them into a normal rhythm, the magnet when taped in place will deactivate the defib so it doesn't work.

In response to beexcellent, the manufacturers of the internal defibs have the magnets available and the ones I've seen and used are indeed the same size and looks like a donut, I'm not positive but I would say the size did matter because it probably has to have a certain strength to "de-activate". Andy