Hi I'm an Acute Hemo/ICU RN in Hawaii. I am trying to obtain information on practices concerning Cardiac Arrest on Dialysis in the chronic setting. I have written a proposal for the purchase of an Automated External Defibrillator(AED) for my employer TRCbut to make a convincing aurgument concerning need for such equiptment I need to know if any outpatient center is currnetly using a defibrillator and or their cardiac arrest procedure. If everyone would please send me such info I would really appreciate the help. Alittle background on AED's:
They are to be used by bystanders and are currently in use in hotels,airplanes,fire and police. They can be used without a MD on site. They are strongly recommeded by the American Heart Association and maybe become leagally mandated. they analyze rythms in code situations and have a 97-98% accuracy rate compaied to human counterparts(I don't remember the percentage). The liability issue is that no one has been sued concerning the use of these devices and the AHA has succesfully aurgued in some states that have made it a requirement to have these devices that there is no harm since persons in arrest are clinically dead. In fact 2 major corporations have been sued becasue they did not have these devices. My proposal is based on the fact that HD patients are at a great risk for arrest due to documented research that they experience Ventricular arrthmias from the 1st 2hrs of treatment to several hours post treatment. Another point is that we need to keep our patients in their dialysis chair or get them back into thier chair faster because of rapid return of spontaneous circulation. and lastly we will save our patients lives. So in saying all of this if anyone could help me out I will greatly appreicate theinformation MAHLO!!!!!!!!!!!

Aloha, Phoenix-- what a tough place to live--Hawaii!!!! The AED in theory sounds like a great idea--- however like any other device-- the people using it will have some legal exposure if it is not used properly--- We addressed this issue several years ago at the dialysis company I worked for. As the attorney and director of risk management for the company-- I had great concerns about having life saving equipment in the facility (i.e. a defibrillator) which was not properly maintained, inspected and used by staff who were properly trained and whose skills remained sharp enough to appropriately use the defibrilator. When the issue of the AED was presented to me, again I expressed my concerns as noted above--Now that the AED's are being placed in different retail and other business environments-- the AED manufacturer must have a level of comfort that the machine is designed such that the (lay person) user of the machine will not inadvertently use the machine on someone who does not need to be defibed. I do believe that we should do all that we can to assist our patients-- and if the use of a defibrillator will safely save lives-- then I think that it may be appropriate to have them available in the facility. However, I would still recommend that the EMTs/parmedics be called immediately--.Also, a concern that I had was how few dialysis facilities had mock codes and how many had expired drugs on the crash cart in the dialysis unit--- the provision of an AED will not serve the useful purpose if employees are not trained and participate in mock codes ( and check the crash cart on a daily basis for the presence of all fully functioning equipment and adequate and current medications.

From a legal perspective-- if one has it-- one had better use it and use it correctly-- including strictly following the manufacturer's guidelines for the maintenance, testing and use of the device... Secondly-- the old adage, "first of all- do no harm" is an applicable refrain.

I would also be interested in the experience that others have had with the use of the AED.. Good luck, Mary