Defibrillator Pads

[christinaaaamarie]

Hello,

So I know every defibrillator pad tells you exactly where to place the pads: one of the right upper chest and the other on the left upper side of the ADULT patient. Question: Sometimes at my work, the nurse places the defibrillator on the back of the patient, like on the scapula. Other times, she places the pad on the left upper chest and the left back. Where are the pads supposed to go? Does the placement vary based on whats going on? When do you know to place the defibrillator pad on the back. Silly question, but Ive been wondering.

Thanks.

[MunoRN, RN]

It largely depends on physician preference, but in general for cardioversions for atrial arrhythmias Anterior/Posterior (A/P) is often preferred because the conduction pathway goes directly through the atria. Our cardiologists usually prefer R chest and L subscapula placement for atrial cardioversions. Some physicians also prefer A/P for ventricular defibrillation as well because in more obese patients the pathway between anterior-anterior placement may not be all that close to the heart.

[AJJKRN]

Next time you're at work open a package of pads and look to see if each pad has a picture/diagram showing where to place the pads. The ones I have used so far have pictures that show which pad goes where but your mileage may vary.

If you do open a package, experiment with hooking them up to the code cart just to get familiar so when the time comes it will be more familiar and go smoother (you'd be surprised at the little things that can be way more difficult when in a hurry/stressful situation).

[brillohead, ADN, RN]

Are you referring to a crash situation, or a treatment situation?

The only time I've seen a recommendation to place one on the back during a crash situation is when the victim is a child and pediatric pads aren't available. Then you put one on the front torso and one on the back torso.

On an adult in a crash situation, upper right chest and lower left side/ribs.

[Rose_Queen, BSN, MSN, RN]

I routinely place my patients' defibrillator pads on the right scapular area and the left side of the torso. They aren't sterile, so they can't be part of the sterile prep for cardiac surgery.

The pads may have recommended placement, but that doesn't mean it's the only placement that can be used. If you're using a biphasic defibrillator (energy goes in both directions), the two pads can even be interchangeable. If you ask me, the primary purpose of the pictures on the pads is to help those who are not routinely placing pads on patients- laypeople, those who rarely see codes, etc. Those who are using defibrillator pads on a daily basis (cardiology, where it's not just about defibrillating but also cardioversions; surgery with sterile field considerations), are going to be used to different placements.

[MunoRN, RN]

From Zoll regarding pad placement: https://www.zoll.com/uploadedFiles/Public_Site/Core_Technologies/Cardioversion/Cardioversion_12_28.pdf

[Lev, MSN, RN, NP]

The anterior-posterior (front and back - usually on left side) positioning can be used for pacing and defibrillation while the anterior-lateral (right chest and left of lower sterum) positioning can only be used for defibrillation. If a patient has an implanted pacemaker the pacemaker site is to be avoided because the shock can damage the pacemaker.