So last night I took a CPR class.

During the AED part, one of the students who has an insulin pump asked what to do if the port is on the side where you would put one of the pads.

There was some debate and the instructors who were new admitted they really didn't know.

I have my thoughts but wanted to know what the correct way to do it is.

quote:

Originally posted by comet24:
So last night I took a CPR class.

During the AED part, one of the students who has an insulin pump asked what to do if the port is on the side where you would put one of the pads.

There was some debate and the instructors who were new admitted they really didn't know.

I have my thoughts but wanted to know what the correct way to do it is.

EMT here. Wow, good question. I never thought of that one, but I imagine the answer is simple. You need to spark the guy or he's dead, so put the pad on where it would normally be placed and cross your fingers. Hopefully the port is non-conductive, and if it isn't maybe the pump gets fried. Oh well, he's going to a hospital anyway, right? They have insulin too

CPR is performed on those with no vitals. The port should not have any influence on the pads, unless the port is physically interfering with an AED's performance. At that point, place closest to where contact can be made.

Regular disclaimer goes here....

I would treat it just like an internal pacemaker/defibrillator. Move the pad slightly away from it.

Unless the port provides a more direct route from pad to pad, I wouldn’t expect much if any interference anyway. Unlike a pacemaker, which has wires going to the heart you’re trying to shock.

I say that as a paramedic of 14 years and a cpr instructor that’s going to renew over 100 CPR recerts this week.

quote:

Originally posted by chongosuerte:
I would treat it just like an internal pacemaker/defibrillator. Move the pad slightly away from it.

This. Or place them on the front and back.

quote:

Originally posted by Gustofer:

quote:

Originally posted by chongosuerte:
I would treat it just like an internal pacemaker/defibrillator. Move the pad slightly away from it.

This. Or place them on the front and back.

Yep!

The pads don’t need to be placed EXACTLY as shown in the suggested diagram. An alternative which is often used especially in instances where you have adult sized pads but a small (eg child) patient is to place the pads front and back with the heart in between. As long as current flows across the heart you should get effective delivery of electricity.

Thanks to everyone that answered.

My thinking was along the same lines but I had never heard the question or even thought of that one.

Wife said usually the port would be down low and not able to interfere. An insulin pump can just be ripped off.

The pads just had to have the heart in the path of them, so they can be moved around a little, usually upper right chest and around the left side.

rip it off, totally harmless to do so. worst case, shock him with the pump on and all the insulin shoots into his system - then he's doa.

Interesting comments on ripping the infusion set off the body?
The device I have you twist the connection of the MiniMed Quick- set, from the portion installed in the body, and only the plastic cannula remains. The pump is now disconnected from the body. The AED leads can be put next the to the remaining infusion set needed. No need to rip anything off. Of course other manufacturers device may different.
Interestingly enough pumps are now used to deliver other pharmacueticals, not just insulin.
As the total infusion set is plastic one could wonder about the conductivity back to the pump if it remained connected?

As noted above, it won't matter. Move it an inch farther away if it makes someone feel better.
Dude or dudette is dead so shock away and worry about the other stuff later when they have a pulse.

quote:

Originally posted by KMitch200:
As noted above, it won't matter. Move it an inch farther away if it makes someone feel better.
Dude or dudette is dead so shock away and worry about the other stuff later when they have a pulse.

Agreed.

There is no threat of it interfering, or diverting the juice. The electricity flows from one pad to the other. The insulin ports aren't going to make the path shorter or easier.

Contrast that with a pacemaker, heavy sweat on the chest, medicine patch with foil backing, etc. The reason these things need to be mitigated are because they may create an unintended path for the electricity (or the batteries may go boom) and the heart may not get the direct hit it needs.

The other reason for avoiding pre-existing conductive objects in or on a patient is heat. There is a reason the pads are as big as they are - to ensure enough surface area for heat dissapation. Same principle for having a large Bovie electrocautery ground pad. Having small metal objects in the path of the current can lead to burns, and if the conditions are right, a fire.

quote:

Originally posted by sakata8242:
The other reason for avoiding pre-existing conductive objects in or on a patient is heat. There is a reason the pads are as big as they are - to ensure enough surface area for heat dissapation. Same principle for having a large Bovie electrocautery ground pad. Having small metal objects in the path of the current can lead to burns, and if the conditions are right, a fire.

Another reason for the electrode size is to ensure enough contact to adequately deliver enough energy to the heart for effective defibrillation.

Also - do a quick scan for any nitroglycerine or other medication patches; they do not respond well to electrical shock (can cause burns &/or decrease energy delivered).

quote:

Originally posted by sakata8242:
The other reason for avoiding pre-existing conductive objects in or on a patient is heat. There is a reason the pads are as big as they are - to ensure enough surface area for heat dissapation. Same principle for having a large Bovie electrocautery ground pad. Having small metal objects in the path of the current can lead to burns, and if the conditions are right, a fire.

Like a bra underwire. Saw that in person (not flaming but the results of smoldering after a shock when arriving as a medic).

I have an insulin pump; I'm voting for ripping off the infusion set. It's just a mini-IV with an adhesive pad. If I'm in defib, I have much more pressing concerns than insulin. It can be replaced later when I'm not about to die.

quote:

Originally posted by chongosuerte:
Like a bra underwire. Saw that in person (not flaming but the results of smoldering after a shock when arriving as a medic).

We're taught to remove bras before applying the AED. Life over limb (over modesty).

First....the insulin "port" should be on the abdomen not on the chest. If it's on the chest, it's in the wrong place anyway.

If I were doing the defib and find that it's in the way , I'd pull that little bugger off in a heartbeat.

You can always give the person a little insulin , if you're lucky enough to get him back.

The priority is defibrillation. If anything diminishes the effectiveness of defibrillation and it can be removed quickly and easily....it's history.

Jmo....mike

PS: It's just a tiny plastic tube that has a piece of adhesive holding it in place. The tube is located just under the skin...not in a vein.

Never seen a patient with an insulin pump port on their chest. Abdomen, thighs, lateral buttocks. No where near where AED pads would go.