Ect nurses role

Electro-convulsive

therapy (ECT)

by:- firoz qureshiDept. psychiatric

nursing

INTRODUCTIONECT is one of the most potent & at

times lifesaving treatment in psychiatry!!

It is one of the most widely used forms of therapy in psychiatric practice

ECT was introduced in the late 1930’s by Cerletti & Bini on the basis of the mistaken idea that epilepsy & schizophrenia do not occur together hence an induced fit would cure schizophrenia.

OUTLINE OF PRESENTATION Definition Objective Indications Contra-indications Types of ECT Technique of ECT Role of the Nurse Before, During ,

& After ECT Side-effects/complications of ECT Dangers of Succinylcholine

DEFINITION

ECT is an electric shock delivered to the brain through electrodes that are applied to both temples. An artificially induced grand mal seizure is produced by passing an electrical current of 70-130 volts for 0.1-0.5 sec. through the head using electrodes

ELECTRO CONVULSIVE THERAPYELECTRO CONVULSIVE THERAPY

OBJECTIVE

To produce a seizure which is established as the essential ingredient for therapeutic effect

INDICATIONS

Depression Schizophrenia Mania Post-partum psychosis Schizo-affective disorders Medical disorders (NMS, Parkinson’s

Disease, etc.)

CONTRA-INDICATIONS

1) Absolutely contraindicated - ICP2) Relatively contraindicated –

Contraindication to ECT – MI (Recent 3 mths.), cerebral infarction, active pumonary disease

Contraindication to anesthesia & other agents - Atropine (Glaucoma, arrhythmias, etc.) - Succinylcholine (Myasthenia gravis, family H/o

pseudo-cholinesterase) - Barbiturates (Hepatic disorders, resp.disorders,

etc.) Psychological contraindications (Hysterical

neurosis, hypochondriasis, OCD, etc.)

TYPES OF ECT

The type of ECT depends on – a) Mode of its administration: Bilateral Unilateralb) Use of other agents: Direct or unmodified (no anesthesia) Indirect or modified ( anesthesia is used)

TYPES OF ECT

The type of ECT depends on –c) Monitoring: Cuff-monitored (common) Multiple monitored (rare)d) Nature of Therapy: Continuation therapy (non-tolerance to

drugs) Prophylactic ECT (Maintenance ECT)

TECHNIQUE OF ECT

ECT Team: Psychiatrist, anesthetist, the psychiatric nurse & paramedical staff

Treatment centre: Waiting hall, preparation room, ECT suite & recovery room

Seizure monitoring: - Hamilton’s Cuff Method - EEG method

Role of Nurse Before ECTNursing Implementation

Rationale

1. Check for written, informed consent from the patient/relative

1. For legal protection

2. Check that a thorough physical examination (including blood Hb, serum electrolytes, urea/creatinine, RBS, Routine Urinalysis, ECG, etc. is done and that results are available

2.. To see if the patient satisfies the inclusion criteria for ECT

Nursing Implementation

Rationale

3. Provide detailed explanation to the patient and relatives

3. This will reduce fear of therapy

4. The patient should be kept nil orally for at least 8 hrs. prior to ECT (3-4 hrs. in case of emergency ECT)

4. To prevent vomiting and aspiration during/after the therapy

5. Remove metallic articles (watch, bangles, ring, hair clips, etc.)

5. Metal is good conductor of electricity

Nursing Implementation

Rationale

6. Remove artificial dentures or check for loose teeth

6. These can dislodge and block the respiratory passage

7. Remove lipstick, nail polish or any other makeup

7. These can mask the presence of cyanosis

8. Loosen tight clothes. Preferably, the patient should be dressed in loose hospital clothes

8. To facilitate respiration, observation of chest and abdominal movements and meet any emergency

Nursing Implementation

Rationale

9.Ensure that the pt. empties bowel/bladder

9.Seizures can lead to incontinence

10. Oil free hair 10. Bad conductor 11. RN who is familiar to the pt.

11. Legal/medical complications are prevented

12.Give pre-medication 12. To anxiety

13. Place the pt. on a trolley in the waiting room

13. To prepare the pt. psychologically for treatment

Nsg. Care During ECTNursing Implementation Rationale 1. Transfer to a well-padded bed in dorsal position

1. To prevent injury & offer comfort

2. Reassure the pt. 2. To reduce anxiety 3. Administer Thio & Scoline. Verify dosage

3. To anesthetize, reduce anxiety and relax muscles

4. Place padded mouth gag 4. To prevent tongue bite5. Support shoulder/arms, restrain thighs with hands

5. To prevent fractures of humerus/femur

6. Hyperextend head with support to chin

6. To prevent jaw #, for patent airway

Nsg. Care During ECTNursing Implementation Rationale

7. Give oxygen (100%) 7. To overcome apnoea

8. Provide electrodes dipped in saline/jelly

8. Good conductor of electricity

9. Note occurrence of GTCS 9.Indicator of efficacy of ECT

10. Suction 10. For patent airway

11. Give oxygen 11. Prevent complications

Nsg. Care after ECTNursing Implementation Rationale

1. Observe, record vitals 1. To prevent complications

2. Put up railings, place lateral positon, wipe secretions

2. To prevent falls, avoid aspiration

3. Record vitals, BP, LOC every 15 mts., once stable every 30 mts till recovery

3. For early identification of complications & quick action

4. Allow pt. to sleep 4. To overcome tiredness

5. Reassure pt. 5. Pts. Are highly suggestible during post ECT phase

Nsg. Care after ECTNursing Implementation Rationale 6. Re-orient to ward,etc. 6. To overcome confusion7. Record/inform injuries/pt.complaints

7. To detect complications (#)

8. Pt. can wash face/bathe

8. Physical well-being

9. Can have clear fluids, later solids

9. Pt is fasting & nutritional needs have to be met

10. Should carry on ADL 10. Pt. to understand ECT is part of therapy

11. Observe, record,report changes

11. To note effectiveness of ECT

SIDE EFFECTS & COMPLICATIONS

• Temporary memory impairment• Dizziness, dryness of mouth, headache,

muscle pain, nausea, vomiting• Unsteady gait, poor concentration, anxiety,

tongue bite, incontinence• Resp. arrest• Missed, Prolonged, inadequate & tardive

seizures• Treatment emergent mania• Delirium

Dangers of Succinylcholine*Abnormal plasma cholinesterase activity

can prolong duration of succinylcholine activity leading to prolonged apnea.This occurs in:

-Genetic abnormal plasma cholinesterase activity ( Shetty, Visya, etc.)

-Decreased hepatic function-Drugs such as organophosphorus

pesticides, etc* Succinycholine can cause excess K+

release in pts. With severe burns