SELF/Perioperative Nursing/Defibrillation with AED

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▼This page is a part of the Perioperative Nursing Curriculum by ECSACONM and SELFPlease see the Intuitive Foundation Terms of Use and do not edit without permission.

By the end of this course, the learner will be able to safely and effectively perform defibrillation with an AED on a patient experiencing sudden cardiac arrest, including the proper setup of equipment, assessment of rhythm, administration of shocks, and post-procedure care and handoff to advanced care providers.

• Explain the signs of sudden cardiac arrest and differentiate shockable from non-shockable rhythms.
• Identify risks and limitations of AED use, including misinterpretation of rhythms and pad-related hazards.
• Describe the sequence of AED setup and pad placement, with attention to perioperative considerations.
• Outline the immediate procedures following AED shock delivery, including CPR and ROSC recognition.
• Explain patient monitoring and documentation requirements after AED use.
• Describe the surgical team’s responsibilities in post-event follow-up, device readiness, and communication with family and staff.

When a patient collapses and is unresponsive, the nurse should immediately assess for signs of sudden cardiac arrest (SCA). This includes checking for unresponsiveness by tapping the patient and calling their name, assessing for normal breathing (not agonal gasps), and confirming the absence of a central pulse such as the carotid. AED use is indicated once these signs are present, as the device is specifically designed to detect and treat ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT), the most common shockable rhythms in cardiac arrest. Non-shockable rhythms, such as asystole or pulseless electrical activity (PEA), will not respond to defibrillation, and in these cases, the AED will advise against a shock and prompt continuation of chest compressions.

For perioperative clinicians, rapid recognition of cardiac arrest in the operating theater requires vigilance since anesthetized patients will not exhibit obvious signs such as movement or speech. Oxygen desaturation, loss of waveform capnography, and sudden loss of arterial line trace are perioperative-specific clues that may suggest arrest. Once suspected, CPR should begin immediately while another clinician retrieves and powers on the AED.

Before applying shocks, nurses must be aware of potential risks associated with defibrillation. Pads must not be applied over medication patches or wet skin, which can increase the risk of burns. Excessive chest hair may prevent effective pad adhesion and electrical contact, and should be rapidly shaved if available. The team must ensure that no one is in physical contact with the patient or bed during shock delivery, as this can inadvertently transmit current to caregivers.

Nurses must also anticipate situations where the AED may be less effective. For example, if the rhythm is fine ventricular fibrillation (low-amplitude VF), the AED may misinterpret it as asystole. To address this, the nurse should carefully inspect the monitor for any very fine, irregular undulations in the baseline, ensure proper pad placement and contact, increase ECG gain or change leads if available, and continue high-quality chest compressions to improve myocardial perfusion until the rhythm is more clearly discernible. In perioperative care, certain drugs (e.g., high doses of potassium or magnesium) or conditions (severe hypothermia) can alter rhythm presentation. Awareness of these limitations helps the nurse interpret AED prompts in the broader clinical context.

Once the AED is retrieved, the nurse should immediately open the unit and power it ON either by pressing the designated button or lifting the lid, depending on model design. The pads must be quickly removed from the sealed package and inspected to ensure adhesive is intact and gel is moist.

The recommended placement is one pad on the upper right chest below the clavicle and the other on the left lateral chest wall below the axilla. This anterolateral configuration provides optimal current flow across the myocardium. The pads must be pressed firmly to ensure full skin contact and avoid air pockets.

Before connecting the pads to the device, the nurse should confirm the skin is clean and dry. If the patient’s chest is moist from sweat, blood, or prep solution, quickly dry it with available material to ensure effective adhesion. In male patients with significant chest hair, shaving the designated pad areas with a razor (if provided in the AED kit) allows direct electrode contact. Once applied, the pads should be connected to the AED cable, ensuring secure attachment before analysis.

When the AED automatically begins rhythm analysis, all rescuers must stop chest compressions and avoid touching the patient. The nurse should verbally announce “Clear” and visually scan to confirm no one is in contact.

After shocks are delivered, the nurse should resume CPR immediately, following AED prompts. In the operating room, continuous monitoring (arterial line, ECG, capnography) may show early signs of ROSC during compressions. If these indicators appear, the nurse should alert the anesthesia provider, who may direct a pause to confirm circulation. Continuous CPR quality—pushing at least 5 cm deep, at a rate of 100–120 per minute, and allowing full chest recoil—is essential while the AED recharges and prepares for potential subsequent shocks.

During perioperative emergencies, AED setup must also account for attached monitors, lines, and drapes. Pads should not interfere with surgical sites, electrocautery plates, or invasive lines. If the left lateral placement is obstructed by sterile drapes, the anterior-posterior pad configuration (one pad on the chest and the other on the back) may be used.

Self-Assessment

Please complete the following: Quiz 1: Defibrilator with AED - ECSACONM

After shocks are delivered, the nurse must closely assess for return of spontaneous circulation (ROSC) when prompted. Indicators include the reappearance of a carotid pulse, an increase in blood pressure on the arterial line, or improved end-tidal CO₂ levels if the patient is intubated. If ROSC occurs, immediate adjustments should be made to support perfusion, including providing supplemental oxygen, monitoring vital signs continuously, and preparing vasopressor support as directed by advanced care providers.

The nurse should inspect the patient’s skin at AED pad sites for burns or trauma. Superficial erythema is common, but deeper burns may require dressing or referral for further care. Pads should be removed only once the patient is stable, and the skin should be cleansed of residual adhesive. Documentation of any injuries caused by the AED, including pad-related trauma, is essential for both medical and legal purposes.

If ROSC has not occurred, the nurse should continue CPR as directed by the AED, pausing only when the device instructs to allow rhythm analysis or shock delivery. Nurses must coordinate chest compression rotations every two minutes to minimize fatigue and maintain compression quality. They should also prepare for adjunctive treatments such as airway management, IV/IO access, and administration of medications like epinephrine. Clear communication with the attending anesthesiologist or physician is crucial to synchronize AED use with advanced interventions.

In perioperative settings, defibrillation may be followed by rapid transfer of care to the surgical or anesthesia team for advanced life support measures. The nurse plays a pivotal role in ensuring smooth transitions—maintaining compression quality, monitoring vital signs, and anticipating the need for defibrillation pads to remain in place in case of recurrent arrhythmias. This vigilance ensures the patient remains stabilized until definitive advanced care is available

Once the acute resuscitation phase concludes, nurses must initiate post-event monitoring and documentation. Continuous ECG, oxygen saturation, and blood pressure monitoring should be maintained, as arrhythmia recurrence is common in the first minutes following ROSC. If advanced care providers are not immediately present, the nurse should keep the AED pads attached to allow rapid re-shock if needed.

Detailed documentation is a critical nursing responsibility. Records should include the time of cardiac arrest recognition, the sequence of events (CPR initiation, AED application, shock times and number of shocks delivered), patient responses, and any complications observed such as burns or rib fractures. This information is vital for handoff to advanced care providers and for later quality review.

The nurse should also ensure that the AED is properly reset and restocked after use. Pads that have been opened or used must be replaced, batteries checked, and the device cleaned. In low-resource facilities where AED availability is limited, ensuring readiness after each use is critical to prevent future delays. Assigning responsibility for post-event device maintenance should be explicitly clarified.

Finally, the surgeon and nurse together are responsible for stabilizing the patient after ROSC, ensuring appropriate hemodynamic and airway support, and determining transfer to the recovery room or intensive care unit when feasible. The surgical team should communicate clearly with the patient’s family about the event, describing the interventions performed and the ongoing plan of care. A structured debrief among the perioperative team should follow, focusing on what was effective, what challenges were encountered, and how future arrests can be managed even more efficiently.

In settings where AED avaliability is scarce, nurses should pre-identify where the nearest functioning device is located and ensure that transport routes are unobstructed. If there are fewer personnel available, the nurse may need to alternate between compressions and AED setup, prioritizing chest compressions at all times. Training in “pit crew” style resuscitation with minimal personnel is helpful, assigning roles clearly (compressions, AED operation, airway).

If supplies such as razors or replacement pads are unavailable, nurses should apply pads directly even if hair interferes, pressing firmly to maximize contact. Pads can sometimes be reused briefly in serial cases if adhesive remains intact, though this should be avoided whenever possible. Documentation and post-event maintenance may also require improvisation—for example, recording times manually if no clock or electronic system is available. Awareness of these limitations allows nurses to plan realistically while still delivering safe, effective care under constrained conditions.

Self-Assessment

Please complete the following: Quiz 2: Defibrilator with AED - ECSACONM

Cumulative Test

Please complete the following: Module Test: Defibrilator with AED - ECSACONM

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