Cardioverter Defibrillator Vest 

Purpose: 

The LifeVest is a wearable defibrillator vest that continuously monitors the resident’s heart to detect life-threatening cardiac arrhythmias. When a life-threatening arrhythmia is detected, the device alerts the resident prior to delivering a treatment shock, allowing a conscious resident to delay the treatment shock. If the resident is unconscious, the device releases a jet over the therapy pads and delivers an electrical shock to restore normal cardiac rhythm. 

Protocol: 

Readmission: 

• The resident is fitted for a vest while in the hospital. Weight and chest measurements are obtained by the vendor representative to ensure an exact fit. 

• The resident is educated on the use of the vest while in the hospital. 

• The hospital provides a backup vest and battery to the resident. 

• Nursing staff are in-serviced on the use of the vest and the appropriate care of the resident. 

Admission: 

• Assess the resident’s knowledge about the appropriate use of the vest. Provide/reinforce education as needed. 

• Ensure that the electrode and therapy pads are in place and that the vest is not too loose. 

• The resident is to wear the vest day and night but may remove it to bathe, shower, or change the garment/vest. 

• Ensure that the vest is turned on. The vest is turned on by inserting the battery. Always have the garment on before inserting the battery. 

Connecting and Disconnecting the Electrode Belt: 

• Follow the instructions in the patient manual. 

• Be careful not to bend the pins. 

Changing and Assembling the Vest: 

• Remove the battery from the monitor before removing the vest. 

• Remove the electrode belt from the vest and insert it into a clean vest. 

• “Silver to Silver”: Ensure the metal sides of the pads (with green sticker) face the metal mesh of the pocket. Snap the pockets closed. 

• “Match the Colors”: Attach the ECG electrodes to the vest. Match the colors on the backs of the electrodes to the colors on the garment. 

• Get the resident dressed by placing “Silver to Skin” – electrodes and therapy pads are pressing against bare skin. The metallic mesh pockets and the metallic side of the therapy pads (with green stickers) MUST TOUCH THE RESIDENT’S BODY for the device to work properly. 

Ongoing Care/Batteries and Vest: 

• The battery is changed and recharged every 24 hours. One battery should be charging while the other battery is in use. 

• The vest should be washed every 1-2 days. Do not use bleach or fabric softener. 

Ongoing Care/Monitoring: 

• Monitor the resident’s vital signs every shift for 72 hours on admission and per MD orders thereafter. Notify MD of any significant findings. 

• Monitor the placement of electrodes and therapy pads every shift. 

• Cardiac rhythm monitoring will be done remotely by ZOLL. The charger unit should be placed near a window. 

Siren Alarms: 

• If the siren alarms and the resident is conscious, the resident needs to act quickly and press the response buttons to stop a treatment shock from occurring. 

• Only the resident should press the response buttons. 

• If the siren alarms and the resident is unconscious, the resident will receive a treatment shock. Leave the vest in place and CALL 911. 

Troubleshooting: 

• If the GONG alerts, follow the instructions on the screen. If unable to correct the problem, notify the ZOLL representative and the resident’s MD. 

Compliance and Documentation: 

• Adhere to CMS guidelines and Requirements of Participation for Long-Term Care Facilities. 

• Document the use of the LifeVest, including the resident’s response and any observations, in their medical record. 

• Note any abnormalities or difficulties encountered during the procedure. 

• Regularly review and update techniques for LifeVest use according to the latest clinical best practices and regulatory standards. 

• Provide training to staff on proper LifeVest use and troubleshooting procedures to ensure resident safety and comfort. 

• Conduct regular audits to ensure compliance with this policy and address any gaps in practice or documentation. 

References: 

• Centers for Medicare & Medicaid Services (CMS). State Operations Manual (SOM), Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. 

• CMS Requirements of Participation for Nursing Homes.