Electro. Magnetic. Therapies. Department. Provider of ECT.
E.C.T. Machine pre treatment set up and safety checks.
Prior to conducting any ECT session it is imperative to ensure the correct functioning of the ECT Machine and its accessories.
A systemic testing regime can assist all operators to evidence that the ECT machine is “fit for purpose” and that the Trust has met it’s obligations in relations to the NHSLA and ECTAS standards i (1.49, 1.50, 1.51, 1.52, 1.53, 1.54, 1.55,1.57, 1.58). http://www.rcpsych.ac.uk/PDF/ECTAS%20Standards%202008.pdf
The Lead Consultant Psychiatrist for ECT is solely responsible for prescribing the ECT machine parameters and is an integral part of the dosing protocol. It is advisable that Two ECT machines are available within the clinic (standard 1.58).
All operators must be able to complete the basic safety checks, to ensure that each ECT machine and it accessories are functioning according to machine manufacture guidance (standard 1.53). It is important that when using sundries that are not supplied by the manufacture, that they meet the recommended specifications. Under no circumstances is it appropriate to make alteration or adaptations of a “home made nature” to medical equipment.
Each ECT machine and the information it produces must be easily identifiable. Appropriate identifier can be inputted to the Thymatron via a computer connection, such as Trust, department, machine number and serial number.
Pre treatment session ECT machine function testing regime.
The following testing regime is suitable for all Thymatron System IV and does not require a computer connect.
If the ECT machine is linked to a computer for the purposes of viewing, uploading and storing of machine generated information, then it is important to start up the computer first and allow time for complete installation before switching on the ECT machine/s. see appendix 1ii
Stage 1.
1. Turn on the ECT machine at the front panel.
2. Allow the ECT machine to complete it internal selftest, this will be indicated on the LED screen on the front panel.
3. Check the dose LED screen which should be showing the lowest dose available in the parameter set. If not select the lowest dose.
4. Check it printer module that sufficient printer paper is available. (To check the paper is correctly fed, press the printer stop/ start button and allow a few leaves to pass).
5. Press the Flexi-dial. In most instances SETTINGS will display in the LED screen. (If this does not happen Rotate the Flexi-dial until SETTINGS is displayed).
6. To check the current SETTINGS, press the printer Stop/ start button. This will result in a single printed leaf of paper containing the parameters that are set.
7. Any subsequent alternation of these setting must be followed by printed confirmation. This printed confirmation of the machine parameters must now checked against your Dosing Protocol and then filed for evidence.
Appendixiii2. For an example of a storage sheet.
Stage 2.
The checking of the ECT machines output / input sockets, leads and electrode paddles with the use of the ECToBrain Patient Simulator. Appendix 3 iv Impedance Test sheet for the Thymatron.
1. Connect to ECToBrain the ECT machines EEG input socket.
2. Connect the Thymapad lead to the ECT machines stimulus output socket.
3. Connect the Thymapads lead ends into the ECToBrain.
4. Switch on the ECToBrain, the green light is displayed. Ensure that the Mode toggle is set on AUTO and the Seizure toggle is set to GOOD.
5. Press the Impedance test button and a reading will display on the LED screen. Note the reading and record it.
6. Press the Treat button as if conducting treatment. Whilst doing so observe the OUTPUT test indicator lights on the ECToBrain. The Green light PASS should be indicated.
7. Allow the EEG to continue until an end point is reached, this will be around 40 seconds.
8. Press the STOP/ Start printer button to end and conclude the recording.
9. If you are not uploading the test. You may wish to store this printer out. However it should be borne in mind that the printer out will deteriorate overtime.
10. Disconnect the ECToBrain from the ECT machine and the Thymapads ends from the ECToBrain. (Note that the ECToBrain will self shut down after a few minutes to safe guard the battery).
Stage 3. Checking your bilateral paddles.
1. With the Thymapad lead still connected to the ECT machine. Attach the bilateral paddles.
2. Place a small amount of conductive gel on the electrode heads.
3. Place both electrode heads together and press the impedance test button.
4. An impedance reading will be displayed in the LED screen. Note and record.
Stage 4, Checking your unilateral paddle.
1. With the Thymapad lead still connected to the ECT machine. Replace one of the bilateral paddles with a unilateral paddle.
2. Place a small amount of conductive gel on the electrode heads.
3. Place both electrode heads together and press the impedance test button.
4. An impedance reading will be displayed in the LED screen. Note and record.
Stage 5. (Repeat of stage 3) using alterative lead.
1. Remove the Thymapad lead from the ECT machine and paddles.
2. Substitute for another lead, this may be the right angled lead.
3. Connected to the ECT machine and attach the bilateral paddles.
4. Place a small amount of conductive gel on the electrode heads.
5. Place both electrode heads together and press the impedance test button.
6. An impedance reading will be displayed in the LED screen. Note and record.
To be read in conjunction with supporting documents.
1 ECT Machine and equipment
1.49 1 The ECT machine is capable of providing stimuli according to current guidelines
1.50 1 Stimulus settings on the ECT machine may be altered easily and quickly.
1.51 1 The ECT machine has a wide range of treatment settings.
1.52 1 Two channel EEG monitoring facilities are available
1.53 1 The ECT nurse ensures that the machine function and maintenance is checked and recorded at least every year or according to machine guidance
1.54 2 An ECT nurse ensures that the clinic is properly prepared, organised and maintained
1.55 1 An ECT nurse ensures that the equipment in the clinic is well maintained
1.57 2 An ECT nurse is responsible for ordering and stocking disposable equipment
1.58 3 There is a suitable back-up ECT machine/ arrangements are in place to obtain a machine from another clinic
Constructed by S.Halsall, October 2010