CARING FOR A PATIENT DURING ELECTRO-CONVULSIVE THERAPY (ECT)

REQUIREMENTS #

1. The following items must be available at the ECT department;
   1. Firm bed with side rails
   2. Screen
   3. ECT machine, headpieces with electrodes in kidney dish with saline
   4. Suction machine
   5. Oxygen cylinder with mask and administration set
   6. Pharyngeal airway (different sizes) laryngoscope, endotracheal tubes and their correct connections
   7. Mouth gags
   8. Tourniquets, swabs, cleansing lotion, plaster, dressing
   9. Trolley with emergency tray
   10. Drugs for use i.e. anaesthetic agents (e.g. Pentothal), muscle relaxant (e.g. Brevidil-suxethomium, scoline-suxemethonium), anticholinergic agent(e.g. atropine)
   11. Assisting nurses
   12. Patient’s folder (Electronic/Manual)

STEPS #

1. Advance Preparation
   1. Prepare bed with necessary accessories
   2. Screen the bed
   3. Identify assisting nurses and tell them their roles
   4. Assemble all equipment required
   5. Check if machine is functioning
2. Put patient in the supine position
3. Ensure the legs are uncrossed and expose hands
4. Assist the anaesthetic/psychiatrist to administer drugs
5. Assist the anaesthetic/psychiatrist to place oxygen mask and administer oxygen as drug takes effect
6. Rub the temples with cotton wool swab soaked in normal saline
7. Place a mouth gag in between the teeth
8. Hold the lower jaw firmly closed against the gag and position head appropriately
9. Instruct the assisting nurse to hold the head pieces against the temples for the shocks to be administered by the doctor
10. Instruct assisting nurse(s) to support the patient at the great joints during the administration of shocks where necessary
11. Observe patient for myoclonic activity(seizure)
12. Turn patient’s head to one side/Put patient in recovery position
13. Check if patient is breathing
14. Take appropriate action as condition demands (e.g. call I/C if there is respiratory distress)
15. Check and record patient’s vital signs every 15 minutes until patient is fully conscious
16. Observe for any injuries sustained
17. Dress any injuries and document
18. Stay with patient until he/she is fully conscious
19. Arrange and take patient to his/her ward when fully conscious
20. Clean and decontaminate equipment and articles used
21. Note and document any observations made during the therapy in the nurses’ notes/patient’s folder