Electrical Cardioversion Protocol: Clinical Procedure Guide

Pre-Procedure Requirements

Patient Preparation

• Verify anticoagulation status (minimum 3 weeks therapeutic)
• Obtain informed consent
• NPO status for 6-8 hours
• Recent baseline ECG
• Current labs including electrolytes and INR

Equipment Checklist

• Defibrillator with synchronized cardioversion capability
• ECG monitor
• O2 delivery system
• Suction equipment
• Emergency cart with ACLS medications
• IV access supplies

Procedure Steps

1. Initial Setup

• Establish IV access
• Apply continuous cardiac monitoring
• Ensure oxygen saturation monitoring
• Position pads/paddles correctly
  • Anterolateral position preferred
  • Ensure good skin contact

2. Sedation

• Administer appropriate sedation per protocol
• Monitor respiratory status
• Document medication administration

3. Cardioversion Process

1. Activate "Sync" mode on defibrillator
2. Verify sync markers on R waves
3. Initial energy settings:
   • Atrial Fibrillation: 120-200J biphasic
   • Atrial Flutter: 50-100J biphasic
   • SVT: 50-100J biphasic
4. Clear area and deliver shock
5. Immediately check rhythm and vital signs

4. Post-Procedure Care

• Continuous monitoring until awake
• Serial ECGs
• Document rhythm outcomes
• Arrange follow-up care

Documentation Requirements

• Pre-procedure assessment
• Anticoagulation status
• Energy levels used
• Number of attempts
• Post-procedure rhythm
• Complications if any
• Patient response

Safety Considerations

• Maintain ACLS readiness
• Ensure proper pad placement
• Monitor for complications
• Follow institutional protocols

Quality Metrics

• Success rate documentation
• Complication tracking
• Patient satisfaction
• Follow-up compliance