Applicable to all License Levels: 

Vector change is changing pad placement during a cardiac arrest for refractory shockable rhythms. This can be considered for shockable rhythms [Ventricular Fibrillation(VF) and/or pulseless Ventricular Tachycardia (VT)] that do not respond to multiple and consecutive defibrillation attempts (3 or more) using conventional Pad placement. If refractory shockable rhythm is suspected this should prompt a CliniCall consultation. 

Indications: 

• Adult patients  

• Refractory shockable rhythms 
  • 3 or more consecutive defibrillation attempts without conversion of rhythm.  
  • PCP/EMR 3 consecutive analyze-shock advised  
  • ACP/CCP/ITT 3 consecutive defibrillation attempts of either VF or VT

Procedure:

Conventional Anterior/Lateral (A/L) Pad placement: This should remain the initial pad placement in Adult Cardiac Arrests to allow for quick application and minimal disruption to high quality CPR. 

Anterior/Posterior (A/P) Pad placement for Vector Change: When you remove the pads from the packaging you will notice that one pad is clearly marked with a red heart. When repositioning pads for vector change from the conventional A/L pad position to the A/P pad position, the lateral pad (red heart indicator) is to be placed over the anterior chest and the pad with no red heart indicator is to be placed posteriorly. Please consider using new pads especially if the adhesive is compromised. This should prompt Clinicall consultation if not already done.  

Easy way to remember pad placement: The back of the pad packaging has a diagram for reference. In either situation, place the pad with the red heart indicator over the patients heart in both the A/L postion or the A/P position. For EMR and PCP license levels, the early phone call to CliniCall will typically occur around the same time vector change would be considered and further instruction can be given if any confusion arises.