POLICY/ PROCEDURE/PROTOCOL
Title: Electrical Therapy for Lethal Dysrhythmias (Defibrillation) - Pediatrics Policy # PED.1
Audience: Pediatric acute care
Key Word: Pediatric, defibrillation Date Page:
Issued:
4/1/08 1 of 3
Distribution: All holders of the policy and procedure manual
Prepared by: Pediatric Standards Committee 11/15/07 Effective
Date: 4/1/08
Approved by: Date:
Pediatric Standards 7/10
Infection Control 1/4/08, 7/14/10
Kaleida Health Nurse Policy Council 3/08, 9/14/10
Kaleida Health Nurse Executive Council 2/08, 10/1/10
Regulation/ Standards- N/A
NYS:
Federal:
Joint Commission:
Review Date 7/10
Revision Date
I. Introduction
This policy identifies the staff authorized to perform pediatric defibrillation and defines the
nursing responsibilities related to it.
II. Communication and Responsibility
Department of Nursing
III. Scope of Practice
RN’s, Physicians, licensed independent practitioners (LIP).
IV. Policy
A. Defibrillation is used to terminate ventricular fibrillation and pulseless ventricular
tachycardia.
B. In pediatrics, defibrillation is performed by the physician or LIP.
C. Nursing Responsibilities include:
1. Call Code Blue and initiate CPR
2. Prepare equipment needed for defibrillation
3. Assess patient condition (before, during and after countershock)
4. Document procedure and outcome
V. Procedure - N/A
Title: Electrical Therapy for Lethal Dysrhythmias (Defibrillation) - Date Page Policy #
Pediatrics Issued: 2 of 3 PED.1
4/1/08
VI. Protocol
A. Supportive Data
Sudden cardiac arrest in children is unusual and is not frequently cardiac in nature.
Asphyxial arrest, which results from progressive respiratory failure or shock, is a major
cause of arrest in children.
B. Content
1. Assessment/Data Collection
a. Refer to manufacturer’s guidelines for set-up of defibrillator.
b. Reassessment of vital signs should occur after five (5) cycles (2 minutes)
of CPR.
2. Care and Management
a. 2005 American Heart Association Guidelines recommend the use of
biphasic defibrillators as opposed to monophasic defibrillators.
**Keypoint: Biphasic defibrillators deliver current in two directions. The
first phase goes from one paddle to the other. During the second phase,
the current reverses direction. Monophasic defibrillators deliver shock in a
single direction – current flows from one paddle to the other.
b. The initial dose for attempted defibrillation of infants and children is 2J/kg;
second and subsequent doses should be 4J/kg.
c. One shock, followed by immediate CPR, beginning with chest
compressions, is used for attempted defibrillation. Rhythm should be
rechecked after 5 cycles (2 minutes) of CPR.
3. Safety
Assure all staff are clear of the patient before delivering charge.
4. Infection Control
a. Maintain Standard Precautions
b. Clean defibrillator after use, as per manufacturer’s guidelines.
5. Complications and Reportable Incidents
Burns resulting from defibrillation
6. Emergency Management – N/A
7. Patient/Family Education
Ensure staff is available to family for emotional support.
VII. Documentation
Document on Code Blue Sheet.
VIII. Teaching Protocol – N/A
IX. References
Amato-Vealey, E., & Colonies, P. A. (2005). Demystifying biphasic defibrillation. ED Insider,
August 2005, 6-11.
Title: Electrical Therapy for Lethal Dysrhythmias (Defibrillation) - Date Page Policy #
Pediatrics Issued: 3 of 3 PED.1
4/1/08
American Heart Association. Highlights of the 2005 American Heart Association guidelines for
cardiopulmonary resuscitation and emergency cardiovascular care. Currents in Emergency
Cardiovascular Care, 16 (4). Winter 2005-2006.
Berg, M., Nadkarni, V., & Berg, R. (2008). Cardiopulmonary resuscitation in children. Current
Opinion in Critical Care, 14, 254-260
Craig, K. J., & Hopkins-Pepe, L. (2006). Understanding the new AHA guidelines, part III.
Nursing 2006, 36 (6), 52-53.
Kaleida Health developed these policies and procedures in conjunction with administrative and clinical departments. These documents were
designed to aid the qualified health care team in making clinical decisions about patient care. These policies and procedures should not be
construed as dictating exclusive courses of treatment and/or procedures. No health care team member should view these documents and their
bibliographic references as a final authority on patient care. Variations of these policies and procedures in practice may be warranted based
on individual patient characteristics and unique clinical circumstances. Please contact the print shop regarding any associated forms.