Defibrillation (Internal)
PREREQUISITE NURSING KNOWLEDGE
• Understanding is needed of cardiovascular anatomy and physiology, principles of cardiac conduction, dysrhythmia interpretation, and electrical safety.
• Advanced cardiac life support knowledge and skills are needed.
• Clinical and technical competence in the use of the defibrillator is needed.
• Knowledge of aseptic and sterile technique is necessary.
• Knowledge of internal paddle placement and energy requirements for internal defibrillation is needed.
• Emergent open sternotomy or thoracotomy precedes internal defibrillation (see Procedures 43 and 44).
• Internal paddle placement should ensure that the axis of the heart is situated between the sources of current.
• Energy requirements for internal defibrillation usually range from 5 to 20 J for biphasic shocks and 10 to 40 J for monophasic shocks.3,4
EQUIPMENT
• Surgical head cover, mask, eye protection, sterile gown, sterile gloves
• Open sternotomy or thoracotomy tray
• Sterile internal paddles (ensure compatibility with the defibrillator)
• Defibrillator with electrocardiogram (ECG) oscilloscope and recorder
• Antiseptic solution (e.g., 2% chlorhexidine-based preparation)
• Large sterile suction catheter, tubing, suction canisters, suction regulator, and suction source
• Flow meter for oxygen administration
• Bag-valve device with mask capable of delivering 100% oxygen and at least 500-mL volumes
• Intravenous access and IV fluids (e.g., 500 mL of normal saline)
PATIENT AND FAMILY EDUCATION
• Teaching may need to be performed after the procedure. 
Rationale: Internal defibrillation usually is performed in the face of sudden hemodynamic collapse.
