Defibrillator Pads- WHERE??

[mrwea1959]

I am trying to write some guidelines for preferred placement of defib pads on a patient for the various procedures that are performed in the EP Lab. Please share your policies/guidelines with me!!

[Flyboy17]

So we do not have a policy since every patient is different and every case is different.

I'll start with an EP study and Right sided Device placement-

We usually have Right IJ Access for our CS catheter. With that being said we place the Right should pad posterior just above the shoulder blade and place the apex pad below the lateral Navix pad that is placed below the patients arm pit. Note: all cables are pointing up over the patients head as so no cables can cross over a sterile field.

For Left sided Device placement-

I will place the Right shoulder pad high up on the chest over the right Clavicle with the Cable pointing up and the Apex pad over the apex as usual. Be sure to run the pad under the patients left arm so the cable can not be pulled on to the sterile Field.

For Cardioversion - I prefer to place all pads anterior and posterior Just left lateral of the Sternum and the spine. This is great for your larger patients since they have more tissue and allows you to press down on the chest during cardioversion to decrease impedence and gets better results. Be sure though to have a buffer such as a folded towel between your hands and the patient.

Please note that placement over the clavicle has not been an issue as far as electrical conductivity for cardioversions/defibrillations

[Rose_Queen, BSN, MSN, RN]

Not EP, but cardiac surgery where we need access to the entire chest: the pad that would normally go under the right collarbone is placed on the back near the scapula. The apex pad is placed on the left lateral side, as far towards the back as possible while still lining up to pass electricity through the heart and not merely through soft tissue.