INTRODUCTION HISTORY MECHANISM OF ACTION INDICATION OF ECT TYPES OF ECT ELECTRIC STIMULUS DURATION OF THERAPY PRE TREATMENT EVALUATION CONTRAINDICATION SIDE EFFECT ELECTROD REPLACEMENT ROLE OF NURSES DOCUMENTATION SUMMARY

1. PRESENTATOR
Ms. SAKUN RASAILY
PAEDIATRIC WARD
BPKIHS

2. TODAYS PRESENTATION LAYOUT
 INTRODUCTION
 HISTORY
 MECHANISM OF ACTION
 INDICATION OF ECT
 TYPES OF ECT
 ELECTRIC STIMULUS
 DURATION OF THERAPY
 PRE TREATMENT EVALUATION
 CONTRAINDICATION
 SIDE EFFECT
 ELECTROD REPLACEMENT
 ROLE OF NURSES
 DOCUMENTATION
 SUMMARY

3. PRE TEST
1 ECT does mean…..
A. Emergency continue treatment
B. Electro convulsive therapy
C. Emergency CT scan
D. a;ll of above
2 Indication of ECT…..
A. Psychotic featuer
B. Stuper
C. Both of above
D. Non of them
3 Side effect of ECT…….
A. Anxiety
B. Confusion
C. Fractore
D. All

4.  Induction of a generalized seizure via the
application of electrical stimulation to the brain
under controlled condition.

5.  Von Meduna, in 1934, used 25% camphor in oil
intramusularly to produce convulsions for the first time
for therapeutic purposes. Later, he used metrazol for the
same purpose.
 A much safer form of convulsive therapy was used by
Cerletti and Bini in 1938. they called it electro shock
therapy. Later, it was k/a ECT.
 1952; introduction of succinylcholine, widespread use
of modified ECT.

6. • In 1970s saw widespread criticism of ECT, with many legislations
passed in the US states, restricting the use of ECT.
• In 1974, the APA council on research and development appointed a
Task force on ECT. In 1976, task force gave its report which provided
clear guidelines for use of ECT and declared it to be a safe method of
treatment when used by professionals trained in the technique.
In 1990 the APA Task Force Report on ECT redefined the indications,
gave guidelines for obtaining consent and set standards for training,
treatment and privileging of ECT

7.  Precise mechanism of action is still not known.
 A small amount of electrical current is sent to
the brain.
 Induces a seizure that causes a biochemical
response affecting the entire brain, including
areas that control mood, appetite and sleep.
 Increases cerebral blood flow, use of glucose
and oxygen.
7

8.  Changes in neurotransmitters
 Releases hypothalamic and/or pituitary hormones
ie. prolactin, thyroid stimulating hormone and
adrenocorticotropic hormone, resulting in
antidepressant effects.

9. 1. Major depressive disorder
 With suicidal risk
 With stupor
 With poor intake of food and fluids
 With melancholia
 With psychotic features
 With unsatisfactory response to drug therapy.

10. 2. Severe catatonia
 With stupor
 With poor intake of food and fluids
 With unsatisfactory response to drug therapy
 Where drugs are contraindicated, or have
serious side-effects
 Where speedier recovery is needed.

11. 3. Severe psychoses (Schizophrenia or mania)
 With risk of suicide, homicide or danger of
physical assault.
 With unsatisfactory response to drug therapy.
 When drugs are contraindicated, or have serious
side effects.
 With very prominent depressive features (eg schizo
affective disorder)

12. 4 Suggestive indications for occasional use:
 Organic mental disorders (organic mood
syndrome, organic hallucinosis, organic
delusional disorder, and delirium)
 Medical disorder (NMS, parkinsonism)

13. Direct ECT
• Absence of anaesthesia
• Only used in developing
country
• Criticised
Modified ECT
• Anesthetic agent (propofol
1mg/kg, thiopentone: 2-5
mg/kg)
• Muscle relaxant
(succinylcholine 0.5-
1.5mg/kg)
• Anticholinergic
(glycopyrrolate 0.2mg,
atropine 0.6 mg)
• Oxygen/ventilation by mask
13

14. 14
 The usual dose for obtaining
adequate seizure response is :
 90-150 volts (average : 110 V)
for 0.1-1 sec (0.6 sec)
Current passed: 200-1600 mA

15.  Usually 6-10 treatments are sufficient although up
to 15 treatment can be given if needed.
 The treatment should be spaced so that no more that
3 ECTs are given per week.

16.  Physical, Neurological and preanesthesia examinations and
complete medical, psychaitry history.
 Lab- blood & urine, chest X- ray, ECG.
 Dental examination.
 Fundus examination- R/O ICP
 Others as per history.

17. Absolute
 Increased ICP
Relative
 Unstable angina
 Recent MI
 Recent stroke
 Retinal detachment
17

18.  Side effects associated with general anesthesia: Death
are usually due to the general anesthesia.
According to APA: (1:10,000 pts or 1:80,000 treatments).
 Memory disturbances These are usually mild and
recovery occurs within 1-6 mnths.
 Confusion may occur in the post-ictal period.
 Other side effects: include headache, prolonged apnea,
prolonged seizure, CV dysfunction, muscle aches.

19. • Memory Impairment
• Restlessness
• Anxiety
• Confusion
• Drowsiness
• Poor Concentration
• Aches; body aches,
headache, painful
masticulatory movement.
• Tongue bite, abrasion of lips
• Fall of teeth
• Dyspnoea, apnoea
• Cardiac Arrest
• Joint Dislocation
• Fracture
• Prolonged Seizure
• Unsteady gait
• Dryness of mouth
• Palpitation, nausea, vomiting
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Immediate
Delayed Effect
Amnesia
Confusional psychosis

20.  Bilateral (BL) - most common, most effective, most
cognitive dysfunction
 Right unilateral (RUL) - less cognitive effect, may
be less clinically effective
 Bifrontal (BF) – may be as effective as BL with less
cognitive effect.
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21. Before ECT
1. Provide emotional support and respond to the
information/educational needs of the patient and family
members.
2. Work to reduce the anxiety of the patient toward ECT.
3. Assist in obtaining informed consent from the patient
and his/her relatives.
4. Prepare all the equipments needed during ECT.
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22.  Functioning ECT machine with accessories
 Conducting gel
 Adequate reserve of Oxygen
 Resuscitation Set
 Ambu Bag, Layngoscope, ET Tube of different size,
Torch, Stylet, 5 ml syringe
 Suction Machine, suction tube
 Bite Block
 Intravenous fluids, equipment and all emergency drugs
 A bed with side rail
 Basic Monitoring Equipment
 An Oxymeter
 ECG monitor
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23.  Assess the completion the Pre-E.C.T. Evaluation: Ordered by Attending
Physician including
 Physical examination
 Vital signs
 Dentition evaluation
 Fundus examination of the eye
 Electrocardiogram
 Other routine lab investigations are guided by the patient’s history and
findings from the physical exam. They may include hemoglobin, electrolytes
and renal function tests.
 Chest x-ray
23

24.  Cervical spine x-ray - if suspected
cervical spine instability
 Anesthesia consultation
 Specialty consultation - advised for
patients with medical conditions with
substantial risk ie. cardiology, obstetrics

25. Explains to patient and completes the following
sequence of events Night Before E.C.T.
Ensure shampoo/shower
No meals for 8 hours prior to treatment.
Nail polish/make-up removed for accurate oxygen
saturation monitoring and proper ECG electrode
contact
Anticonvulsants such as carbamazepine, used in
epilepsy and as mood stabilisers, increase seizure
threshold and decreaseseizure duration. There needs to
be discussion with the patient'sconsultant about
continuing prescription.
Reassure the patient and his /her relative.
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26. On the morning of ECT
 Maintain NPO status, (as outlined above)
 Re-check doctor’s order and E.C.T. consent
 Do blood sugar levels and document (if ordered)
 Do pre E.C.T. vital signs and document
 Ensure Body weight is recorded on E.C.T.
checklist
 Hold all the oral medicine except
• Anti-HTN
• Anti-GERD/reflux .
• Glaucoma medicine
 Consult the treating doctor and anaesthetist to send the
patient on exact time to OT.
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27.  Check all the consultation and investigation and legal
document
 Dentures/glasses/hearing aids - remove unless agency
policy allows to wear during transport. Remove contact
lenses, jewelry, hair accessories
 Give thorough mouth care to facilitate suctioning and
airway management
 Have patient void bladder and bowels prior to treatment
 Assess patient’s level of anxiety. Provide patient with
support and reassurance
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28.  Keep all the equipment
ready
 Introduce the patient
with each members of
team.
 Ask patient to empty the
bower and bladder
 Ask the patient to
remove the prosthesis,
if not removed.
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29.  Insert the I/V cannula
 Reassure the patient
 Keep electrode for various monitor.
 Monitor vital signs and oxygen saturation
 Clean areas of the patient’s head with alcohol swabs and / or gel at
the sites of electrode contact.
 Injection atropine 0.6mg subcutaneous or IM is administered before
ECT
29
• The anaesthetic, muscle relaxant and oxygen are administered.
• Keep the patient in supine position, shoulder supported with the rolled
tower and chin lifted and head tilted position. Explain the purpose of
this position to patient.
• The anaesthetic, muscle relaxant and oxygen are administered.

30.  Insert a disposable or autoclavable bite block
into the patient’s mouth.
 If required and in the absence of the
psychiatric trainee, the nurse can assist the
treating psychiatrist by pressing the test / treat
button on the ECT machine.
 Record the duration and type of seizure with
the seizure threshold of patient.
30
.
100% Oxygen@ 5 lit/min. till spontaneous respiration returns.
Shift the patient after achieving spontaneous respiration and maintaining
SpO2.

31.  Receive the detail information from ECT nurse about the
patient.
 Receive the patient, assess airway, vital signs, physical and
mental status.
 Provide oxygen as needed.
 Assess the frequency of observation required based on the
patient’s return to pre E.C.T. vital signs and level of
consciousness (eg. q. 15 min., q. 30 min., q 1 hour).
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• In case of headache, muscle aches, analgesic such as
paracetemol may be administered.
• Provide adequate rest to the patient.
• Assess the safety of the patient’s environment and his/her
readiness to ambulate and to swallow before giving
medication and breakfast.

32.  Provide frequent reassurance and reorientation until the patient
retains the information.
 Assess patient for nausea, headache, confusion, delirium.
 In case of post ictal confusion, verbal interaction is usually
ineffective, provide small dose of benzodiazepine according to
doctor’s order.
 Use side rail to prevent fall injury.
 Document any side effects of treatment and interventions provided.
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• The ECT nurse should clean and replace the equipment used during
ECT.
• Ensure patient is supervised by a responsible adult for 24 hours
following treatment, including off-ward activities.
• Re-involve patient in regular care plan activities/meals as tolerated.
• Provide clear orientation to person, place, time, and situation and
reorient according to the need.
• Reassure the patient if he develops memory loss

33.  Discusses effects of E.C.T. with patient/family
including concerns, side effects, improvement of
symptoms.
 Maintain an ongoing education/information
process with patient and/or family.
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34.  Ensure the following documentation is completed:
 pre-treatment assessment data and interventions
 patient/family education provided including their
response to the education
 the informed consent process
 post treatment assessment data and interventions
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35. ECT PROCEDURE

38. 1 ECT does mean…..
 Emergency continue treatment
 Electro convulsive therapy
 Emergency CT scan
 all of above
2 Indication of ECT…..
 Psychotic featuer
 Stuper
 Both of above
 Non of them
3 Side effect of ECT…….
 Anxiety
 Confusion
 Fractore
 All
POST TEST

39. REFERENCES
1. www. Slide share.com
2. ECT – YouTube
3. Electroconvulsive therapy (ECT) - Mayo Clinic
4. What is ECT? (psychiatry.org)
5. Electroconvulsive Therapy (ECT) Benefits & Side Effects
(webmd.com)