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How to Use a Manual External Defibrillator

By Patricia Nevins, RN, MSN ; Updated March 16, 2018

Operating a manual defibrillator (cardioverter) requires familiarity with the equipment at hand. There are many types of manual defibrillators, each with differences, such as what the monitor face and controls look like and what type of self-adhesive defibrillation pads are used. These differences in equipment can lead to significant delays in care resulting in poor outcomes for patients experiencing cardiac arrest. If you anticipate having to operate a manual defibrillator, know what equipment will be available to you ahead of time.

Prepare the Equipment

Place defibrillator on a solid, dry surface.

Turn on the manual defibrillator. Depending on the model, there might be a dial to turn or a power button to push. Defibrillators have batteries and should be fully charged. If the defibrillator monitor shows low battery output, plug the defibrillator into a power source, or obtain another manual defibrillator.

Insert the connecting cables into the receptor on the manual defibrillator.

Attach the self-adhesive defibrillation pads to the connecting cable leads.

Apply Paddles or Self-Adhesive Defibrillation Pads

Remove self-adhesive defibrillation pads from packaging and connect pads to conducting cables. If using paddles, connect paddles to monitor by inserting adapter into receiving port identified on the manual defibrillator.

Apply conducting gel to paddles or ensure that self-adhesive defibrillation pads are moist with sufficient conducting medium. If the pads were not properly sealed in the packaging, the conducting gel may dry out and not perform properly. In this case, get a new set of pads.

Apply paddles/pads to the chest. There are two placement options for defibrillating. With paddles, use the anterolateral placement. If using a manual defibrillator with self-adhesive pads, the anteroposterior is preferred, but if a patient cannot be moved, or it is difficult to reach the patient's back, use anterolateral placement. 1) Anterolateral: one paddle/pad is placed to the right of the upper sternum, below the clavicle (collar bone) and one paddle/pad is placed to the left of the left nipple with the center of the paddle/pad in the midaxillary line (imagine a line extending down from the middle of the arm pit.) 2) Anteroposterior: One paddle/pad is placed over the left side of the chest, below the clavicle and the other is placed on the left side of the back below the shoulder blade and to the left of the spine.


Set the energy level for electrical discharge. There are two types of manual defibrillators: biphasic or monophasic. 1) Biphasic waveform devices have device-specific energy levels that are indicated on the defibrillator. If you do not know the device specifics, the default initial energy setting is 200 joules (J). 2) Monophasic waveform device energy setting is 360 J for all defibrillation attempts.

Press the “charge” button on the manual defibrillator. If you are using paddles, there also is a charge button on the paddles.

Discharge the defibrillator by pressing the “shock” button on the manual defibrillator or, if using paddles, the discharge button on the paddles.


Ensure good self-adhesive defibrillation pad contact with the skin. If using paddles, press the paddles down firmly onto the chest. It takes 25 pounds of pressure to get good contact with the skin. Good contact is necessary to ensure that the majority of the energy passes through the body to the heart.


Make sure everyone, including the operator of the manual defibrillator, is clear, which means no one has contact with the patient or equipment while the shock is delivered. If using paddles, the person delivering the shock is only touching the paddles.

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