DEPARTMENT:
SCOPE: Poudre Valley Hospital and Medical Center of the RockiesPOLICY:GENERAL INFORMATION:Deactivation of AICDs at the end of a patient’s life is a comfort care measure as it decreases pain for the patient. Due to the infrequency of deactivation, the providers as well as nursing staff are unfamiliar with this process.Placing a magnet over the AICD will not turn off the pacemaker. It will start the asynchronous pacing mode and will not deliver a shock if the heart goes into an arrhythmia. PROCEDURE:Documentation of a discussion with patient and/or family is required and can be documented in the progress notes. The discussion should include the following points:Patient may experience pain near the end of life if the AICD delivers a shock.Deactivation of the defibrillation function will disable the device from delivering a shock if the patient has a fatal heart dysrhythmias. It does not disable asynchronous pacing function. Deactivation of the AICD device does not cause death or pain to the patient.Discussion of deactivation of pacemaker functions should be made separately as this may affect the symptoms a patient experiences and may cause death to the patient if pacemaker dependant. Process for deactivation:Physician order present on chart.Consultation can be requested with a cardiologist or one of the cardiology nurse practitioners to reprogram the AICD in order to deactivate it.If reprogramming the AICD is not available, a magnet can be placed over the device and kept in place in order to turn off the defibrillator function. The magnet can be obtained from a cardiovascular telemetry technician.The patient’s nurse must tape the magnet over the device and leave it in place until the patient is pronounced dead. It is recommended to keep the magnet in place until the family has gone. It can then be removed before the patient 's body is prepared for the morgue.References:LIII – Goldstein, N., Carlson, M., Livote, E., Kutner, J.S. (2010). Management of implantable defibrillators in hospice. Annals of Internal Medicine. 152(5), 296-299. doi:10.1059/0003-4819-152-5-201003020-00007.LI -- Russo, J>E> (2011). Original research: deactivation of ICDs at the end of life: a systematic review of clinical practices and provider and patient attitudes. American Journal of Nursing. 111(10), 26-35. doi:10.1097/01.naj.0000406411.49438.91. ................
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