BY Monika Devi NR M.Sc.Nursing GMCH Jammu

1. ECT and its Nursing
management
Monika Devi NR
M.Sc.Nursing
GMCH Jammu

2. Electroconvulsive Therapy :-
 Electroconvulsive therapy (ECT) is a
procedure in which electric currents are
passed through the brain, intentionally
triggering a brief seizure.

3. History-
 In 1785, the therapeutic use of seizure
induction was documented in the London
Medical Journal.
 Convulsive therapy was introduced in 1934
by Hungarian neuropsychiatrist Ladislas J
Meduna.

4. Contd..
 Italian Professor of neuropsychiatry Ugo
cerletti, and his colleague Lucio Bini in
1937, experimented ECT for the first time
on a person.
 Through the 1940s and 1950s, the use of
ECT became widespread.

5. Definition
 Electroconvulsive therapy (ECT),
formerly known as electroshock, is a
psychiatric treatment in which seizures are
electrically induced in anesthetized patients
for therapeutic effect.

6. Indications
The indication for ECT are-
1. Major severe depression.
2. Severe catatonia.
3. Severe psychosis.
4. Schizophrenia.
5. Mania.

7. Mechanism of action
 the exact mechanism of action of ECT
remains elusive.
 One hypothesis states that ECT possibly
affects the catecholamine pathway
between the diencephalon and limbic
system also involving hypothalamus.

8. Technique-
The technique used for ECT administration
are of two type-
1. Direct ECT.
2. Modified ECT

9. Electrodes-
according to placement of electrodes ECT is
of 2 types-
1. Unilateral.
2. Bilateral

11. Drugs given along with ECT-
1. Atropine 0.6mg
2. Administration of anesthetic agent like
propofol 0.75-2-5 mg/kg or thiopentone 2-
5mg/kg.
3. Muscle relaxant succinylcholine 0.5-1.5
mg/kg.

12. Contra indication-
1. Absolute- increase ICP.
2. Relative-
 Recent MI.
 Severe Hypertension.
 CVA.
 Retinal detachment.

13. Side effects-
1. Effects on memory- The acute effects of
ECT can include amnesia.
2. Side effects of general anaesthesia.
3. Confusion.
4. Other.

14. Nursing Care in ECT
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.

15. Providing Educational and
emotional support
1. Explain the procedure to the patient
2. informed consent
3. Respond to patient’s concerns and
feelings.
4. Educate the patient concerning the
procedure
5. Initiate education interventions based on
knowledge deficits.

16. Pre-treatment Nursing care
 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.

17. Contd..
 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

18. Nursing Care during ECT
Procedure
 Transfer the patient on a trolley from the
waiting room to the ECT room on a well
padded bed
 Apply ECG electrodes, BP cuff, and pulse
oximetry sensor.
 Give a short acting anaesthetic agent and
succinylcholine
 Prepare EEG electrodes.

19. Contd..
 Prepare scalp and apply electrodes
(unilateral vs. Bilateral).
 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

20. Contd..
 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.
 Do suction immediately
 Restore respiration by giving O2 if
necessary.

21. Post-ECT Care
 Observe and record the vital parameters
 Place the patient on side lying position,
clean the secretions
 Transfer the patient from recovery room .

22. Contd..
 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.