An Automated External Defibrillator (AED) delivers an electric shock to restart the heart’s natural rhythm during sudden cardiac arrest. Correct pad placement is crucial for effective defibrillation, ensuring the electrical current effectively reaches the heart and improves outcomes.
Standard Adult Pad Placement
The most common method for adults is anterior-lateral placement, ensuring the electrical current passes through the heart efficiently. One pad is positioned on the upper right chest, below the collarbone and to the right of the sternum, avoiding bone.
The second pad is placed on the lower left chest, below the armpit and lateral to the left nipple, resting on the rib cage. This creates a clear electrical pathway through the heart, with current flowing from upper right to lower left. Proper adhesion to bare skin is essential for effective shock delivery.
Before applying pads, expose the patient’s chest for direct skin contact, removing any obstructing clothing. Press firmly on each pad to eliminate air pockets and ensure complete skin contact. This firm contact allows for optimal electrical conductivity and maximizes successful defibrillation.
Alternative Placement Techniques
While anterior-lateral placement is standard, anterior-posterior pad placement is an alternative for specific circumstances. This method involves placing one pad on the front of the chest, typically over the sternum, and the other on the back.
The second pad is placed on the patient’s back, between the shoulder blades and to the left of the spine. Ensure the back pad does not overlap the front, as this could create a short circuit and reduce shock effectiveness. This technique is used when standard placement is not feasible.
Anterior-posterior placement may be necessary for individuals with large breasts obstructing standard placement, or when implanted medical devices like pacemakers or ICDs are present. This prevents direct standard pad placement and provides an alternative pathway for the electrical current.
Overcoming Placement Obstacles
Common obstacles can impede proper AED pad placement and adhesion. Excessive chest hair prevents pads from sticking firmly; many AED kits include a razor or scissors to quickly remove hair for direct skin contact.
Wet skin, from sweat or other liquids, reduces pad adhesion and conductivity. Quickly dry the patient’s chest with a towel or cloth before applying pads to ensure optimal contact.
Individuals may have implanted medical devices, such as pacemakers or ICDs, appearing as small bumps under the skin. Position pads at least an inch away. Placing a pad directly over a device could damage it or reduce shock effectiveness.
Medication patches, like nitroglycerin patches, must be removed from the skin where AED pads will be applied. After removal, quickly wipe the area to remove any residue, as some medications can interfere with conductivity.
Small jewelry or piercings pose little risk, but large metallic objects in the electrical current’s path should be considered. If a large metallic object is present where a pad needs to go, move it if possible, but do not delay defibrillation to remove jewelry.
For individuals with large breasts, place the lower left pad on the bare skin of the chest wall, not on breast tissue. Gently lift or move breast tissue to expose the rib cage area below the armpit for correct and effective pad application.