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

1. ELECTROCONVULSIVE
THERAPY AND ITS
NURSING MANAGEMENT
PRESENTED BY
PANKAJ SINGH RANA
NURSE PRACTITIONER

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 used in ECT
1. Atropine 0.6mg
1. Administration of anesthetic agent like
propofol 0.75-2-5 mg/kg or thiopentone 2-
5mg/kg. (propofol because it keep gag refelex
intact and thio is ultra short acting sedative)
1. Muscle relaxant succinylcholine 0.5-1.5 mg/kg.
( Succinylcholine because it is short acting (15
min max. Before giving we should check the
potassium level)

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.