Definition
Electroconvulsive therapy (ECT) is a physical therapy, in which there is an application of electrical current to the temporal region of the brains to produce a grand mal type of seizure, for bringing about therapeutic effects.
Indications for Electroconvulsive Therapy
- Major depression.
- Involutional melancholia.
- Schizophrenia.
- Mania.
- Postpartum depression.
Contraindications for Electroconvulsive Therapy
- Increased intracranial pressure.
- Recent myocardial infarction.
- Cerebral haemorrhage.
- Glaucoma
- History of cardiovascular diseases.
- Pregnancy.
Articles
- ECT machine, electrodes.
- ECG monitor.
- Pulse oximeter.
- Defibrillator.
- Suction apparatus.
- Oxygen cylinder and AMBU bag.
- Mouth gag and tongue depressor.
- Sterile syringes and needles.
- IV stand.
- Emergency drugs.
- K-basin.
- Electroconductive gel.
Procedure for Electroconvulsive Therapy
| Nursing actions | Rationale | |
| Preparation for ECT | ||
| 1. | Identify the patient and explain about procedure to the family and patient. | Helps in obtaining cooperation from patient. |
| 2. | Check if a thorough physical examination is completed which includes assessment of the cardiac, respiratory, skeletal system, etc. and investigations for like routine blood and urine tests such as Hb%, TC, DC, and urine for glucose, albumin and X-ray. | These findings help rule out contraindication or risk of the patient for ECT. |
| 3. | Get a written consent from the nearest relative after explaining the purposes, method of treatment and risks involved. | Prevents legal problems. Explanation to the relatives will help them to overcome fear of therapy. |
| 4. | Patient should be kept nil per orally from midnight, of the previous day. | Helps to prevent risk of vomiting and aspiration during and after the procedure. |
| 5. | Instruct the patient not to apply oil to head, on the day of ECT, and to wash hair using shampoo. | Oil is a bad conductor of electricity. |
| 6. | Remove all metallic articles from his/her body, e.g. watch, bangles, ring, safety pin, etc. | Prevents the electric current passing on unwanted areas, and causing burns since metal is a good conductor of electricity. |
| 7. | Remove artificial dentures. | Prevents dislodging and blocking of the respiratory passage. |
| 8. | Remove lipstick, nail polish or any other makeup. | These colours may mask any changes, if present, e.g. cyanosis. |
| 9. | Provide a loose gown. | |
| 10. | Administer medication as per physician’s order. | Enhances the effectiveness of ECT. |
| 11. | Encourage patient to empty the bladder before entering treatment room. | Prevents soiling of bed due to a relaxant effect of the drugs administered. |
| 12. | Give injection atropine 0.6 mg IM or SC half to one hour prior to Electroconvulsive therapy as per order. | Blocks the vagal nerve and thus decreases oropharyngeal secretions. |
| 13. | Check vital signs. | Helps to evaluate the condition of patient. |
| 14. | Administer tablet Lorazepam or Calmpose if ordered. | Relieves anxiety of patient. |
| 15. | Transfer the patient to the waiting room. | |
| Assisting with administration of Electroconvulsive Therapy | ||
| 16. | Shift the patient to ECT room. | |
| 17. | Provide a well-padded bed with a pillow under lumbar curve. Patient can be placed in a supine position. | Well-padded bed helps to prevent injury. |
| 18. | Administer short acting anaesthetic agents like thiopental as prescribed by physician. | Muscle relaxant and anaesthetic are used to reduce violent convulsive attacks. |
| 19. | Place well-padded mouth gag or tongue depressor between the teeth. | Prevents tongue bite, injury to lips, and obstruction of airway caused by falling back of tongue. |
| 20. | Support the shoulder and arms lightly and restrain the knee joints firmly but gently. | Prevents fracture. Tight pressure may lead to fracture of femur or humerus. |
| 21. | Hyperextend the head with support to the chin. | Prevents jaw dislocation or fracture and facilitates patent airway. |
| 22. | Administer 100% oxygen by using face mask. | Helps the patient to overcome a phase of apnoea after convulsions. |
| 23. | Provide electrodes dipped in gel for placement (Electrodes may be placed as bilateral, unilateral or bifrontal). | Gel is a good conductor of electricity, thereby facilitates passing of current and production of convulsions. |
| 24. | Observe grand mal seizures. Initial tonic stage lasts for 10-15 seconds, followed by convulsions lasting for 25-30 seconds. Then there is a phase of muscular relaxation. | Ensures that treatment is successful and there are no subshocks. |
| 25. | Do suction of mouth immediately. | Keeps airway patent and prevents from aspiration pneumonia. |
| 26. | Restore respiration by giving oxygen by mask if required. | Prevents the patient from respiratory and cardiac complications. |
| Care after ECT | ||
| 27. | Check and record vital signs. | Evaluates any respiratory or cardiac complications. |
| 28. | Put the side rails of bed up and place the patient on side-lying position. Wipe the secretions. | Prevents falling of patient due to restlessness. Side-lying position avoids aspiration. |
| 29. | Transfer the patient to the recovery room when he can answer simple questions. | Ensures that patient has come out of the phase of unconsciousness. |
| 30. | Check vitals every 15 minutes till stable and record. | Helps to evaluate signs and symptoms of complications, if any. |
| 31. | Encourage the patient to sleep for some time. | Helps the patient to overcome physical exhaustion. |
| 32. | Shift the patient to ward. | |
| 33. | Reorient the patient to the ward, toilet, nurse’s station, etc. | Reorientation helps to overcome the state of confusion. |
| 34. | Check for any injury pain, headache, etc. | Helps to detect any complications, specially fracture. |
| 35. | Encourage the patient to drink clear tea followed by soft solids. | Meets the nutritional needs as they are kept nil per orally (NPO-Nil-per-OS) from previous midnight. |
| 36. | Record any change observed after ECT. | Evaluates the behavioral pattern after receiving ECT. |
Complications
- Impairment of memory.
- Fracture and dislocations.
- Aspiration pneumonia.
- Headache and backache.
- Painful mastication.
- Injury to mouth and tongue.
- Subshocks.
- Confusion.
Special considerations
Before starting the procedure, check for supply of electricity and ensure that ECT machine and suction apparatus are in working condition.
- Ensure informed consent is obtained, explaining risks and benefits.
- Conduct a pre-ECT assessment, including medical history, neurological status, and medication review.
- Verify NPO (nothing by mouth) status to prevent aspiration during anaesthesia.
- Assist with positioning to prevent injury during the induced seizure.
- Ensure proper oxygenation and airway management during anaesthesia.
- Observe for confusion, headache, or temporary memory loss, which are common side effects.
- Provide reorientation and reassurance as the patient regains consciousness.
- Monitor for complications, such as prolonged seizures or cardiovascular instability.
- Involve family members in post-ECT care planning.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- R.Sreevani, A Guide to Mental Health & Psychiatric Nursing, 6th Edition, 2024, Jaypee Publishers, ISBN 978-9366161686
- Sheila L. Videbeck, Psychiatric Nursing, Seventh Edition , 2017, Wolters Kluwer Publications, ISBN: 978- 1496355911
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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