Automated External Defibrillators (AEDs) are portable medical devices that deliver an electrical shock to the heart during sudden cardiac arrest. This helps restore a normal heartbeat when the heart stops effectively. Correct placement of AED electrode pads is essential for effective and safe defibrillation. Proper pad positioning ensures the electrical current travels efficiently through the heart, maximizing the chance of successful defibrillation.
Adult AED Pad Placement
For adults, typically individuals 8 years or older or weighing over 55 pounds (25 kg), the standard AED pad placement is the anterior-lateral position. Place one pad on the upper right side of the chest, just below the collarbone. Position the second pad on the lower left side of the chest, beneath the ribcage and below the left nipple, often aligned with the bottom portion of the pectoral muscle. This placement creates an optimal pathway for the electrical current to pass directly through the heart.
To apply the pads, expose the patient’s chest by removing all clothing. Peel the backing off one adhesive pad and place it firmly on the upper right chest. Place the second pad on the lower left side of the chest. Pads often feature diagrams to guide proper placement and ensure full adhesion.
While anterior-lateral is the most common adult placement, an anterior-posterior (front-back) placement may be used in certain situations. This alternative involves placing one pad on the front of the chest, over the breastbone, and the other pad on the patient’s back, just below the shoulder blade. This method is advantageous if standard placement is hindered by medical implants like pacemakers, excessive breast tissue, or body piercings, ensuring the electrical current still traverses the heart effectively.
Pediatric AED Pad Placement
Pad placement for children and infants differs significantly from adults due to their smaller body size and lower energy requirements for defibrillation. Pediatric pads, also known as attenuated pads, are specifically designed for individuals typically under 8 years old or weighing less than 55 pounds (25 kg). These specialized pads deliver a reduced electrical shock, often attenuating the energy to about 50 Joules, which is safer for a child’s smaller body. The reduction in power is achieved either through the pad’s wiring or by a switch or key on the AED unit itself.
For pediatric patients, the anterior-posterior placement is commonly recommended. One pediatric pad is placed on the front of the child’s chest, usually on the upper left side or center. The second pad is then placed on the child’s back, precisely between the shoulder blades. This front-and-back positioning is crucial to ensure the pads do not touch each other, which could happen with a child’s smaller chest if adult anterior-lateral placement were attempted. This method also guarantees that the electrical current passes effectively through the heart.
If pediatric pads are unavailable in an emergency, adult AED pads can still be used on a child or infant. In such cases, it is important to use the anterior-posterior placement to prevent the larger adult pads from overlapping. While adult pads deliver a higher energy shock, using them is generally considered preferable to delaying treatment, as every minute without defibrillation decreases survival chances.
Ensuring Effective Pad Contact
Achieving proper contact between the AED pads and the patient’s skin is paramount for effective and safe defibrillation. Before applying the pads, it is essential to ensure the patient’s chest is bare and dry. Remove all clothing from the chest area, cutting it if necessary. If the skin is wet from water or sweat, quickly dry the area thoroughly, as moisture can reduce pad adhesion and interfere with electrical current delivery, potentially causing burns.
Excessive chest hair can prevent the pads from adhering properly, reducing the effectiveness of the electrical shock. Most AED kits include a small razor to quickly shave the areas where the pads will be placed. If a razor is not available, pressing the pads down very firmly may help establish contact.
Furthermore, any metal jewelry, such as necklaces or piercings, should be removed or moved away from the pad placement sites to prevent interference or arcing. Medicated patches on the chest should also be removed, and the skin wiped clean before pad application, as they can block current and cause burns. After placement, press down firmly on the entire surface of each pad to ensure full adhesion and eliminate air pockets.