biphasic defibrillators

[neneRN, BSN, RN]

We've just acquired a biphasic defibrillator in our ER and some staff members are having a debate as to the number of joules used. Our educator giving the inservice on it states that you still shock with 200, 300, 360. Other nurses are arguing that we should be using less joules because it is biphasic. I've been staying with the standard 200, 300, 360 and the docs aren't stating to use anything different; but I have noticed that the pts are jerking way up off the stretcher with the shocks-more so than with the monophasic.

So, if anyone is using the biphasic, please post how many joules you're using. Also, if there is anywhere that I can get this info written, i.e manufacturer's recommendations or whatever, I would appreciate it. Thanks!

[NurseGirlKaren]

We only use lower energy for cardioversions with the biphasic. For defibrillation, we still use 200, 300, 360.

[2ndCareerRN]

You really need to look in the operators manual, or call the manufacturer of the biphasic defib you are using.

Different manufactureres of the biphasic defib set a different joule level as the optimum shock level.

I worked at one ED where we stacked @ 150 joules with the biphasic. If that failed we would go to 200 joules.

This was in line with the recommended settings put out by the manufacturer.

You can also do a google search on "biphasic defibrillator" and find all kinds of information and studies done.

bob

Edit: Here is just one of the many case studies tha have been done on biphasic defibs.

http://www.medical.philips.com/main/products/resuscitation/products/fr2plus/case_studies/casestudy_schneider2000.html

[Zee_RN, BSN, RN]

My understanding is that you're supposed to use a lower energy when using the biphasic defibrillator but that many doctors just can't get out of the mind set of using 200, 300, 360 and use it anyway.

[amy]

In my previous ED, it was decreased joules with the biphasic. The whole etiology and rationale behind the biphasic is that it transfers the shock not just one way thru the heart, but thru then back. The monophasic hsocks one-way, therfore requiring increased joules. The biphasic is also supposed to be more like the actual pattern of conductivity of the heart, resulting in a more effective ''shock''. If you use the traditional joules, then you essentially 'fry' and damage the cardiac muscle. If not a formal, then take your own informal pole; what is your success rate, do you notice increased topical burns from contact with the paddles? And, by all means, get your fingers on one of those owners' manuals. I am surprised there was not inservice to all by the rep to ensure proper use and effectiveness...ours was mandatory. Good luck!

[toronto rn]

We have been using the biphasic defibrillators for over a year now. The ones we have are programmed to defibrillate at 120, 160, and 200 joules. Cardioversion starts at even lower joules. There is less impedence with the biphasic defib as the shock goes from one paddle to the other and back, reducing impedence. The defibrillator can also act as an external pacemaker and the patient can be defibrillated through the pacemaker pads as well once they are in place.

[petiteflower]

We have the lifepack 20---according to what the rep told us when we bought it (and I am not sure he knew what I was talking about) it reads 200 300 and 360 but is actually shocking at the lower biphasic level.

What has really scared me though is NONE of our docs knew what a biphasic defibrillator was!!!!

[atownsendrn]

We have a biphasic defib on order. Hopefully, the rep will come do an inservice and will know what he/she is talking about. I have always heard that the joules are decreased. I would read the service/operating manual. And do what is says. As far as the docs go - you know sometimes that you just have to tell the how the "machines" work.

[J_W, DNP, APRN, CNS]

We have them. Of course the type of rhythm you are shocking is important. For cardioversions of AFlutter you can start with as low as 30j, though you will not see a doc start this low. Cardioversion of VT with a pulse you could start at 50j..Narrow complex SVT also might convert at 50j.

But for VF or Pulseless VT the three shocks are 120, 150 and 200. Our biphasic defibrillators only charge to a max. of 200j no higher. Remember the concept of biphasic technology is that is delivers the shock from one pad to the other and back, so in essence you are shocking the patient twice. Therefore you will need less energy. Remember the more energy you use the more myocardial damage that occurs. every time you shock someone you damage myocardial cells, no real way around that.

[zambezi, BSN, RN]

Our biphasic also shocks at 120, 150, and 200j...to cardiovert we start at 30j...

[nowplayingEDRN]

Our facility uses the Agilent HeartStream XL biphasic defibrillator. The recommended shocking sequence for adults is150 straight across the board. Peds, still follows the PALS recommendations based on weight.The company that makes your defibrillators should have training materials in addition to the user's manual that will help you become accustom to the equipment and the recommended joules to defibrillate at.

[TracyB,RN, RN]

150j for adults