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APPENDIX III: LOCATION, EQUIPMENT, AND SUPPLIES A. The Treatment Suite The treatment suite should consist of a well lit and well ventilated treatment area, and adjoining but separate recovery and waiting areas. If feasible, the waiting area should be sufficiently separate from the treatment and recover areas as to insulate the waiting patient from auditory and visual contact with the treatment and recovery areas, as well as from patients being transported between the latter two locations. Dedicated space should be made available within the treatment suite for ECT related equipment, supplies and records. The ECT suite is located on the first floor in Building 82, Wing D. B. Equipment 1. Treatment Area PILGRIM PSYCHIATRIC CENTER Issue Date: 10/1/97 Revision Date: 2/20/2001 Reviewed Date:2/20/2001 Page 38 of 58 Subject: ELECTROCONVULSIVE THERAPY (ECT) Facility Policy Issuing Office: Clinical Services Equipment should be available to induce a seizure, monitor physiologic response, maintain an airway, deliver positive pressure ventilation, and provide resuscitation in case of cardiovascular or respiratory difficulties. In the morning of each ECT treatment day, before ECT is administered, the ECT Nurse shall verify the status and availability of the following supplies and equipment in the treatment area: a. ECT treatment device, with ready access to a back-up unit b. Device for monitoring the electrocardiogram (ECG) c. Manual sphygmomanometer or automatic device for monitoring blood pressure d. Sphygmomanometer for use in monitoring convulsion duration e. Stethoscope f. Oxygen delivery system capable of providing intermittent positive pressure oxygen by mask or endotracheal tube 9. Intubation set and endotracheal tubes h. Suction apparatus i. Reflex hammer j. Stretcher or bed with firm mattress and side rails, and capability of easily elevating both head and feet. k. Pulse oximeter l. Peripheral nerve stimulator m. A defibrillator 2. Recovery Area In the recovery area, the ECT nurse shall verify the status and availability of the following supplies and equipment: a. Oxygen delivery system capable of providing intermittent postive pressure oxygen by mask or endotracheal tube. b. Pulse oximeters c. Suction apparatus d. Sphygmomanometer e. EKG monitoring equipment f. Oxygen tanks. PrImary Medications (for intravenous administration unless stated otherwise) PILGRIM PSYCHIATRIC CENTER Issue Date: 10/1/97 Revision Date: 2/20/2001 Facility Policy Reviewed Date:2/20/2001 I Page 39 of 58 Issuing Office: Clinical Services Subject: ELECTROCONVULSIVE THERAPY (ECT) 1) primary anesthetic agent (methohexital sodium) 2) succinylcholine 3) anticholinergic agent(s) (glycopyrrolate and atropine sulfate) 4) intravenous fluids (glucose in water, glucose in saline) 5) agents for terminating prolonged or spontaneous seizures and ameliorating postictal delirium ( e.g. iorazepam, diazepam, diphenylhydantoin) 6) beta adrenergic blocking agents (e.g. labetalol) 7) alpha adrenergic blocking agents ( e. g. prazocin clonidine) 8) pressor agents such as epinephrine,dopamine, & norepinephrine 9) vasodilators such as hydralazine and nitroglycerin tablets and/or ointment 10) emergency cardiac agents sufficient for first-line management of arrhythmia, cardiac arrest, and both hyper and hypotension (e.g. Digoxin, lidocaine, verapamil, bretylium and procainamide) 11) agents to allow initial management of anaphylactic shock (e.g. Epinephrine, diphenhydramine, aminophylline) 12) anti-nausea agents 13) physostigmine D. Additional Medications 1 ) alternative anesthetic agents, e.g. propofol E. Other Necessary SuppIies (sufficient In amount to handle all anticipated needs) 1) masks for delivery of oxygen 2) airways (assorted sizes) 3) mouth guards (bite-blocks) - soft rubber, autoclavable 4) infusion sets 5) syringes and needles (assorted) 6) monitoring electrode pads and leads 7) electrode gel or paste 8) recording paper for monitoring use 9) alcohol, acetone, and/or ethyl acetate 10) gauze pads, tape (assorted) 11) stimulus/monitoring cables for ECT device F. Machine Safety All external physiological monitoring devices in the treatment room that are PILGRIM PSYCHIATRIC CENTER Issue Date: 10/1/97 Revision Date: 2/20/2001 Facility Policy Reviewed Date:2/20/2001 Page 40 of 58 Issuing Office: Clinical Services Sub ct: ELECTROCONVULSIVE THERAPY (ECT) connected to the patient will be electrically isolated and will be connected to the same grounded circuit. Biomedical Engineering will inspect all new electronically powered equipment prior to initial use and twice per year thereafter, and log their findings with Central Supply. Each inspection will include the procedures recommended by the manufacture in the ECT Device Service manual. Operations manuals for equipment are filed in the ECT suite and available for reference. Equipment will be cleaned once per week or after each use, whichever is more frequent. If the ECT physician, or any other ECT staff, notices any problems with the ECT treatment device (thymatrom), the device is to be taken out of service immediately, and tagged indicating that it is non-operational with a description of the problem. Thymatron is also to be notified. Thymatron will provide a replacement machine within 48-hours, and service the equipment. Back up devices are available through Central Supply for all other equipment. If any equipment fails, a Med Watch form is to be completed by the ECT physician, and submitted to the Medication Error Subcommittee of the DMC for review and notification. |
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