Electroconvulsive Therapy: Prepared by Sharada Kunwor Assistant Professor, BNC

ELECTROCONVULSIVE
THERAPY
Prepared By
Sharada Kunwor
Assistant Professor, BNC
Introduction
• Over the years, there have been
development of several biological
methods of treatment for
treatment of psychiatric disorder.
• Among those treatments,
electroconvulsive therapy has
been revised extensively and still
used.
• Previously known as shock therapy
but “seizure therapy” is a better
term.
Introduction …
• The stimulus is applied through electrodes that are placed
either bilaterally in the fronto-temporal region or unilaterally
on the same side as the dominant hand.
• Conventional ECT uses fixed current amplitude of 800 or 900
mA (milliampere) (0.8 or 0.9 volts) for all patients.
• The duration of current flows can be between 0.7-1.5 seconds.
• The duration of the seizure should be at least 15 to 25 seconds
(20-50 seconds). Most clients require an average of 6 to 12
treatments, but some may require up to 20 treatments.
• Treatments are usually administered every other day, three
times per week.
Definition
• Electroconvulsive therapy is a treatment in which
a grand mal seizure is artificially induced in an
anesthetized patient by passing an electrical
current through electrodes applied to the
patient’s head (Mankad et al, 2010).
• Modified electroconvulsive therapy (mECT) is a
controlled medical procedure in which a seizure is
induced in an anaesthetized patient to produce a
therapeutic effect. (Kavanagh & McLoughlin,
2009)
Indications
 It is recommended that ECT is used only to
achieve rapid and short-term improvement of
severe symptoms after an adequate trial of
other treatment options has proven
ineffective, patient preference, when the
condition is considered to be potentially life-
threatening in individuals with:
Indications …
1. Severe depressive illness. With suicidal risk
(This is the first & most important indication for
ECT)
2. Catatonia.
3. Severe psychoses (schizophrenia or mania)
4. Other Conditions: neuroses, obsessive-
compulsive disorders, personality disorders
(Little evidence exists to support the efficacy of
ECT in the treatment of these conditions).
Contraindications
• Absolute contraindication: Increased
intracranial pressure (brain tumor, recent
cardiovascular accident, cerebro-vascular
lesion).
• High risk: Myocardial infarction, severe
underlying HTN, congestive cardiac failure,
severe osteoporosis, acute and chronic
pulmonary disorders, high-risk or complicated
pregnancy.
Types
According to technique
• Direct ECT: In this, ECT is given in the absence

of anaesthesia and muscular relaxants. As of
now it is commonly used method in Nepal.
• Modified ECT: In this, ECT is modified by drug

induced muscular relaxation and general
anaesthesia.
According to placement of electrodes
• Bilateral: Bilateral
electroconvulsive therapy
refers to the placement of
electrodes on both sides of the
head during the administration
of electroconvulsive treatment.
• It is considered more effective
and is used more commonly
than unilateral and bifrontal
placement.
According to placement of electrodes …
• Unilateral: In unilateral ECT, one electrode is placed

at the top (vertex) of the head and the other
typically on the right side.
• Bifrontal: In bifrontal electro convulsive therapy, the

electrodes are placed on the frontal area, 5cm
above outer canthus of the eyes. It has emerged as
an alternative option to the conventional
bitemporal and right unilateral electrode placement
in view of fewer cognitive adverse effects.
Side Effects
• The most common side effects of ECT are
temporary memory loss and confusion.
• Headache, nausea, vertigo, muscle pain.
• Mortality of ECT The death rate estimated to
be less than 1 per 70,000 treatments.
Equipment necessary for ECT
• 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
Equipment necessary for ECT…
• 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
Equipment necessary for ECT…
• 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.
Nursing Management
1. Providing educational and emotional

support
2. Pre-treatment planning and assessment
3. Preparing and monitoring the patient during
the actual procedure
4. Post-treatment care and evaluation
1. Providing Educational and emotional
support
• Explain the procedure to the patient
• Obtain an informed consent from the patient and
the carer.
• Respond to patient’s concerns and feelings.
• Educate the patient concerning the procedure
and explain to the patient the necessary tasks
associated with ECT.
• Initiate education interventions based on
knowledge deficits.
2. Pre-treatment planning and assessment
• Preparation of treatment suite for the ECT

procedure
• An adjustable height stretcher trolley
• Complete the pre-treatment check list.
• The patient’s identity is checked and the patient
wears an identity bracelet.
• Ensure safekeeping of the patient’s valuables.
• NPO for minimum 4 hours before treatment to
prevent possible aspiration during anaesthesia.
2. Pre-treatment planning and assessment…
• The patient’s hair should be clean and dry to allow for

electrode contact.
• Hairpins, bracelets, body piercing should be removed to avoid
burns.
• The patient should be encouraged to pass urine before the
treatment to avoid incontinence during the procedure.
• Prostheses, dentures, glasses, hearing aids, contact lenses,
should be removed.
• Minimize anxiety through anxiety management techniques,
ensuring short waiting time and offering reassurance and
support.
• Standard practices should be practiced regarding general
anaesthesia care.
3. Nursing care during ECT procedure
• 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).
• Prepare EEG electrodes, per treatment specifications.
• Prepare scalp and stimulus ECT electrodes (unilateral vs.
bilateral) and apply paste to electrodes.
3. Nursing care during ECT procedure…
• 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.
• Take note of the duration of seizure.
• Do suction immediately
• Restore respiration by giving Oxygen if necessary.
4. Post ECT care
• Place the patient on side lying position, clean the
secretions.
• Observe and record the vital parameters
• 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.
• Allow the patient to sleep for 30 min to one hour
• Reassure the client and reorient to the ward
• Allow the patient to have tea or any drinks
• Record the procedure
Documentation
• Document using flow sheets or progress notes.
• Record the patient's vital signs and responses
during the treatment sequence, recovery, and
post-recovery.
• Document medications, stimulus parameter,
seizure response and vital signs
• Assess and document the patient's physical and
mental status and any behavioral changes or
lack of such changes

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ELECTROCONVULSIVE

• Direct ECT: In this, ECT is given in the absence

• Modified ECT: In this, ECT is modified by drug

• Unilateral: In unilateral ECT, one electrode is placed

• Bifrontal: In bifrontal electro convulsive therapy, the

1. Providing educational and emotional

• Preparation of treatment suite for the ECT

• The patient’s hair should be clean and dry to allow for

• Transfer the patient on a trolley from the waiting room

• Support the shoulder and arms of the patient.

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