Nursing Care in ECT
Nursing Care in ECT
Nursing Care in ECT
Introduction
ECT is a physical therapy in which with the help of electrodes, electrical current is passed to the brain to produce
generalized seizures.
Modified electroconvulsive therapy (ECT) is a controlled medical procedure in which a seizure is induced in an
anaesthetized patient to produce a therapeutic effect. (Kavanagh & McLoughlin, 2009)
Electroconvulsive therapy (ECT) is a highly technical procedure requiring a team that consists of an anesthetist, a
psychiatrist, psychiatric nurses, and recovery nurses.
Psychiatric nurses have an important role in caring patients who receive ECT.
ECT is the most acutely effective treatment available for affective disorders and is more effective than antidepressant
drugs. (Kavanagh & McLoughlin, 2009)
ECT may be considered as a primary treatment (or first-line treatment) for persons exhibiting syndromes such as: severe
major depression, acute mania, mood disorders with psychotic features, and catatonia. ( Hogan MF & Paterson DA, 2008)
1. Severe depression
2. Acute mania
3. Mood disorders with psychotic featues
4. Intolerance to side effects of medication or other treatments
5. Deterioration in condition, or appearance of suicidality or pronounced lethargy.
6. Acute catatonia
Contra-indications
Contraindications to ECT include brain tumors, space-occupying lesions, and other brain diseases that cause
increased intracranial pressure.
Electroconvulsive therapy is treated like a minor surgical procedure that requires preoperative preparation and
postoperative care. (Arkan B, Ustün B, 2008). There are four components of nursing care in ECT
Transfer the patient on a trolley from the waiting room to the ECT room on a well padded bed and placed in a
comfortable dorsal position or supine position. A small pillow is placed under the lumber curve.
Apply ECG electrodes, BP cuff, and pulse oximetry sensor (not on same extremity as BP cuff).
Give a short acting anesthetic agent. Thiopental .25mg to .5 mg , IV and secoline (succynyl choline) 30-50 mg.
The dose of drug may vary from patient to patient.
Prepare EEG electrodes, per treatment specifications.
Prepare scalp and stimulus ECT electrodes (unilateral vs. bilateral) and apply paste to electrodes.
Support the shoulder and arms of the patient. Restraint the thigh with the help of a sheet.
Hyperextension of the head with support to the chin.
Administer oxygen
Apply jelly to the electrodes
Make the observations of the convulsions.
The presence of initial tonic stage which lasts for 10-15 seconds followed by clonic stage which lasts for 25-30
sec then there is a phase of muscular relaxation with stertorus respiration ie flaccid stage.
Do suction immediately
Restore respiration by giving O2 if necessassry.
Post-ECT Care
Transfer the patient from recovery room . record vital signs every 15 min for 30 min and once in every 30 min till
the patient recover to the normal stage.
Treatment devices and supplies, including electrode paste and gel, gauze pads , saline, electro encephalogram
electrodes and chart paper.
Monitoring equipments including ECG and EEG electrodes
BP cuffs, peripheral nerve stimulator and pulse oxymeter
Stethoscope
Reflex hammer
Intravenous and venipuncture supplies
Stretchers with firm mattress with side rails with the capacity of raising the head and foot end
Bite blocks
Suction device
Ventilation equipment, including tubing , masks, Ambu bag, oral airways , intubations equipments with an oxygen
delivery system capable of providing positive- pressure oxygen
Emergency and other medications as recommended by the anesthesia staff
Miscellaneous medications not supplied by anesthesia staff for medical management during ECT such as
midazolam, diazepam, thiopental sodium, glycopyrolate, succinyl choline etc.
Documentation
Conclusion
Psychiatric nursing care for the electroconvulsive therapy (ECT) patient has evolved from a traditional supportive and
adjunctive practice to the current practice of independent and collaborative nursing actions. The nurse's multifaceted role in
ECT is enacted by providing education and support, performing pretreatment assessments, monitoring the procedure, and
observing and interpreting posttreatment patient responses. (Burns & Stuart GW, 1991)
Although in use for 70 years, ECT continues to attract controversy and there is considerable stigma associated with its use
that often overshadows the empirical evidence for its effectiveness. One way to overcome this is for health professionals to
be educated about contemporary ECT practice. Patients need to make informed decisions when consenting to ECT and
this process can be influenced by preconceived ideas and scientific fact. (Kavanagh & McLoughlin, 2009).