Practice Information

AICD/Pacemaker Interruptions with a Magnet during Colonoscopy Procedures


To: Interested Parties

From: Barbara Zittel, RN, Ph.D, Executive Secretary, State Board for Nursing

Subject: AICD/Pacemaker Interruptions with a Magnet during Colonoscopy Procedures

Date: February 2009

The Board has recently been asked to opine on whether it is within the scope of practice of a Registered Professional Nurse (RN) to disable an Automatic Implanted Cardioverter Defibrillator (AICD) through use of a surface magnet. The question was further limited to situations in which a electrocautery is being applied during a colonoscopy procedure in a Gastrointestinal Lab.

The purpose of an automatic implanted cardioverter defibrillator (AICD) is to monitor and correct rapid heart rates (ventricular tachycardia /fibrillation) and, in some instances, to pace the heart in situations of slow heart rates (bradycardia). During procedures using electrocautery the AICD may mistake the cautery's current as an episode of fibrillation and unnecessarily shock the patient. To prevent such occurrences, a magnet, provided to each patient with an AICD, can be placed on the chest wall over the AICD to temporarily disable the defibrillator. If during the colonoscopy procedure an emergency occurs requiring defibrillation, the magnet can simple be removed from the patient's skin and the AICD will automatically reset and defibrillate as required.

It is the position of the State Board for Nursing that registered professional nurses (RNs) licensed and currently registered by the New York State Education Department may apply a magnet to temporarily disable an AICD given the following conditions:

  • A patient-specific order must be written by a physician for use of the magnet,
  • A physician must be in attendance the entire time that the magnet is attached to the patient,
  • Cardiac monitoring must be performed continuously throughout the procedure,
  • An emergency code cart must be immediately available,
  • The facility must provide education and skill training, with input from the Cardiology Department, to RNs providing this procedure,
  • The facility must have a written institutional policy and procedure, with input from the Cardiology Department/cardiologist, describing the role of the RN in this procedure,
  • The RN must be able to document the completion of appropriate education and clinical competence in the procedure,
  • The facility must provide competency assessment of each RN's ability to provide this procedure. Such assessment must be documented in the personnel file of each RN and updated annually,
  • A complete nursing assessment must be performed and documented prior to each treatment,
  • Prior to discharge the patient's AICD must be evaluated by the facility's cardiac electrophysiology lab/cardilogist.

Failure to comply with these guidelines may place the nurse at increased risk for a charge of unprofessional conduct especially in a situation involving a bad patient outcome.

This procedure is not within the scope of practice of a Licensed Practical Nurse.

If you have additional questions, please contact Barbara Zittel, Executive Secretary to the State Board for Nursing by: mail at the above letter-head address; e-mail: nursebd@nysed.gov; phone: 518-474-3817 ext. 120; or fax: 518-474-3706.

Last Updated: January 31, 2013