Correct Placement of AED Electrode Pads | Wellbeing

1. Patient Preparation

Begin by completely removing clothing from the patient's chest. To expedite this process during an emergency, it may be necessary to cut the clothing off using the scissors typically provided in the AED kit. The two defibrillation electrodes must be placed directly on the patient's bare skin, which should be clean and dry. If the victim is wearing any metal jewelry or accessories (such as necklaces), these must be removed as metal conducts electricity and can cause burns or interfere with the shock.

In cases where the victim has excessive chest hair, you should shave the areas where the pads will be applied if a razor is immediately available; excessive hair can prevent the pads from adhering securely to the skin, leading to poor connectivity. Additionally, if the patient is wearing a bra, it must be removed (cut off) before pad placement to avoid metal underwires and ensure direct skin contact. Once the electrodes are taken out of their packaging, connect them to the defibrillator unit (if not pre-connected) and peel off the protective plastic backing.

2. Standard Pad Positioning (Anterior-Lateral)

Most AEDs feature diagrams on the back of the electrodes themselves, illustrating exactly where they should be applied on the chest.

The standard placement, known as the anterior-lateral position, involves the following:

• The First Electrode (Right): Place this pad on the upper right side of the chest, directly below the right collarbone (clavicle) and to the right of the breastbone (sternum).

• The Second Electrode (Left): Place this pad on the lower left side of the chest, along the mid-axillary line (the side of the rib cage), approximately a few inches below the left armpit and to the left of the nipple.

However, standard placement is not always feasible. For instance, if the patient has an implanted pacemaker (visible as a lump under the skin) or an open wound at the standard site, you must avoid placing the pad directly over these areas. In such cases, alternative positions may be used, such as the Bi-axillary position (placing pads on opposite sides of the rib cage) or the Anterior-Posterior position (one pad on the chest, one on the back), though standard placement is preferred when possible.

3. Placement for Pediatric Patients

For children, the placement strategy depends on the equipment available. If the AED is equipped with pediatric pads or a pediatric mode, the standard anterior-lateral position described above can be maintained.

However, if only adult electrodes are available which are often too large for a small child's chest and risk touching each other you must use the Anterior-Posterior position. Apply one pad to the center of the child's chest (left of the sternum) and the other pad to the center of the child's back (between the shoulder blades). This "sandwich" technique ensures the electricity passes through the heart without the pads overlapping (arcing).

4. Analysis and Shock Delivery

Once the pads are securely applied, the AED will instruct rescuers not to touch the patient in order to analyze the heart rhythm and detect any abnormalities. During this analysis phase, the machine determines whether an electric shock is necessary. It will provide one of two indications: "Shock Advised" or "No Shock Advised."

If a shockable rhythm is detected, you will be instructed to press the shock button. Crucial Safety Step: Before pressing the button, visually verify and loudly announce "Clear!" to ensure absolutely no one is touching the victim. Press the button to deliver the shock, then immediately follow the AED's instructions to resume Cardiopulmonary Resuscitation (CPR). If the machine indicates "No Shock Advised," do not deliver a shock; instead, immediately resume CPR as directed by the voice prompts until the next analysis cycle (typically every 2 minutes).