Nursing Education

forElectroconvulsive Therapy

By:

Alisha J Dancy MSN RN

https://www.youtube.com/watch?v=DCUmINGae44

Learning Objectives

Identify diagnosis for ECT

Identify equipment needed

Explain electrode placement

Seizure duration

Explain mini mental exam

Identify post procedure monitoring

Describe discharge requirement

List 3 contraindications

List 3 common ECT side effects

Medications contraindicated for ECT

History of Electroconvulsive Therapy Observation of spontaneous seizure benefit on

Schizophrenia

1938 start of using Medications

1939 Italian doctor use of electric stimulation

1939 1st United States ECT

Decline in popularity in the 1970

Purpose for This Education

Inform nurses of evidence based recommendations

Educate the nurses on the actual procedure

Inform or reeducate nurses of ECT complications

Improve nurses clinical practice

Definition of ECT

ECT is a method where electric currents are passed through the brain, deliberately triggering a momentary seizure. Through this electrical stimulation of the brain, ECT appears to produce alterations in brain chemistry that can enable a rapid reduction in the signs and indicators of selected psychiatric and mental health disorders, e.g., severe depression and bipolar disease.

Mayo Clinic, 2013

Mechanism of Action

The mechanism of action is unknown

Research determined that ECT increase monoamine transmitters (dopamine & serotonin)

ECT increase the release of central neuro peptide, the neuro endocrine hypothesis suggest insufficiency of the hypothalamic mood maintaining peptide

MRI revealed reduction in global connectivity

Ultimately, our brain and CNS is so complex there is no clear, definitive answer on exactly how ECT works

Indications for ECT

Patients who are resistant to pharmacological interventions

and present with:

Major Depressive Disorder (MDD) Bipolar Disorder Schizophrenia Parkinsonism, not responding to medication

Equipment /Supplies

Nurses responsibility is to ensure availability and set-up of:

ECT machine

Electrodes

Gel

Cardiac monitor

Pulse oximetry

Bite Block

Blood pressure

machine

Suction machine

Mini Mental Exam

The MMSE is a reliable tool that takes 5 minutes to complete the focuses on

Appearance

Behavior

Cognition

Thought Process

Ballas, C. (2012)

Stages of nursing process

ECT patients sequence process

Pre Procedure Area

Treatment Room

Recovery Room

Phase II

Kavanagh & McLoughlin (2009)

Pre-Procedure

Pre-Op Nurses

Completes the pre- ECT checklist consisting of:

Verification of NPO status Removal of jewelry/clothing

etc. Verifying allergies Verifying patient awareness of

the procedure

Pre-Procedure cont.

Obtaining baseline vital signs Verifying medical clearance Existence of Laboratory results Verify existence signed

consents Obtain intravenous access

Additionally, the nurse must be knowledgeable of medications and conditions with increased risk

Pre Procedure cont.

The anesthesia provider will verify and assess the patient pre procedure for necessary components essential for anesthesia

e.g.: airway , allergies, NPO status, medication for anesthesia

The psychiatrist is the healthcare provider who administers the ECT

e.g. diagnosis, treatment dosage

The ECT Procedure

Anesthesia is administered

Electrodes place either unilaterally, bilaterally and bifrontal

The electrical impulse of 70 - 150 V

The desired seizure duration of 15-50 seconds

Chemical changes occur

Series lasting 6 to 12 therapeutic sessions

Followed by ECT maintenance

Phase I/ Recovery

Nurse Responsibility The patient is assessed and monitored according to best

practice standards and facility guidelines as follows:

Provide continuous cardiac monitoring

Blood pressures every 15 minutes or less

Continuous Pulse Oximetry

Assess LOC /Mini Mental Exam

Discharge Criteria Blood pressure within 20% of baseline

room air saturation at baseline,

follows commands,

no post op nausea/ headache

oriented to person place & time

Phase II/ Recovery

Once discharge criteria is met the patient then transitions to the next level of care

Inpatient room Outpatient –home with responsible adult

D/C Criteria Includes:

Oriented x 3

Tolerating food and drink

No nausea, headache

Side Effects/Adverse Reactions

memory loss- anterograde and retrograde nausea headaches muscle aches

Tardive seizure – rare potentially fatal

Considered safe for children, pregnant women and elderly

ECT current death rate is approximately 2 per 100000 treatments

Condition with increased Risk/ Contraindications

Vascular aneurysms Central nervous system conditions

associated with ↑ intracranial pressure Some brain tumors Recent cerebral infarct Severe pulmonary or other organ

system disease presenting ↑ anesthesia risk

No true contraindications for ECT

Contraindications cont.

Increased risk of complications from

electrical stimulation

Recent myocardial infarctionCongestive heart failureValvular heart disease

Medication Contraindications

Anticonvulsants

Interfere with seizure production

Antieleptic mood stabilizers

Tapered and stopped before ECT

Benzodiazepines

Potential anticonvulsant

 Lithium

Neuro toxicity & poor outcome

https://www.youtube.com/watch?v=-T0mwzXHgvI

Conclusion

ECT is a safe treatment for patients who are resistant to other forms of therapy

The continued success of ECT patients outcomes are dependent on the ECT team especially the nurses who care for the patients and are knowledgeable in their assessment and care pre and post procedure.

Thank You