CARDIAC MONITORING
FEBRUARY 2022
CARDIAC MONITORING
OUTLINE
Definition
Purposes
Indications
Types of Monitoring Lead System
Code of Lead Wires Attached to the Patient
Procedure
Special Considerations
Definition
Is a non-invasive procedure that displays
the electrical activity of the heart; these
electrical impulses are picked by the
surface electrodes and are transported
and then recorded in the ECG.
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Electrodes (small, plastic patches that stick
to the skin) are placed at certain points on
the chest and abdomen. The electrodes are
connected to an ECG machine by wires.
Then, the electrical activity of the heart can
be measured, recorded, and printed. No
electricity is sent into the body.
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A cardiac event monitor is a device that
you control to record the electrical
activity of your heart (ECG). This
device is about the size of a pager. It
records your heart rate and rhythm.
Cardiac event monitors are used when
you need long-term monitoring of
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Purposes
Provide a continuous graphic picture
of cardiac electrical activity.
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Purposes
Monitor oxygen saturation of the
arterial blood.
Help in diagnosis of life threatening
problems, as cardiac dysrhythmias.
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Indications
Patients with suppressed respiratory
system by a drug overdose or
anesthesia.
Monitor the pattern of a patient’s
heart rhythm pre- and post- surgery.
Monitor abnormal heart rhythms.
DLSL Monitor the effect of cardiac
medications have on a patient’s heart
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Types of Monitoring Lead
System
All cardiac monitors use lead system
to record the electrical activity
generated by cardiac tissue.
Cardiac monitoring systems currently
on the market vary from three-
electrode telemetry devices to three,
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systems.
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Procedure
1. Assessment
• Assess the patient need for cardiac
monitoring.
• Patients with primary cardiac diagnoses inclu
ding acute coronary syndrome, post‐cardiac s
urgery and arrhythmia, are the most likely to b
e n e f i t f r o m
cardiac monitoring. In practice, continuous ca
rdiac monitoring has been used to detect sign
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s of haemodynamic instability.
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Procedure
2. Preparation
A. Environment
*Bedside monitor
*Machine cables
*Three electrodes
*Sponge with alcohol
*KY gel
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*Scissors
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Procedure
2. Preparation
B. Patient Skin
*Shaving (for adolescent)
*Disinfectant with alcohol or soap
*Keep the skin dry
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Procedure
3. Implementation
Initiating ECG monitoring:
*Explains the purpose of ECG
monitoring to the patients and family.
*Applies the electrodes to the
appropriate location and attaches the
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correct cables to each electrode.
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Procedure
3. Implementation
Note: Electrodes are to be changed
every 24 hrs (or depending on the
institution’s guidelines) and selects an
appropriate lead in which to monitor the
patient.
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Procedure
3. Implementation
*Check cables and lead wires for
fraying, broken wires or discoloration.
*Plug lead wires into patient’s cable.
*Plug the patient’s cable into monitor.
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Procedure
3. Implementation
*Turn on the monitor.
*Adjust the monitor.
-Speed (25mm/sec)
-Sets the appropriate alarm limits
based on the initial rate/rhythm and
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ensures alarms are set to ON position.
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Procedure
3. Implementation
-Note: Pediatrics – Alarms are set
that are appropriate for the age or as
ordered by the physician.
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Procedure
Post Care
A. Patient
*Reassure the patient
B. Environment
*Discard the used items.
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Procedure
Post Care
C. Nurse
*Record ECG strips from the
monitor.
*Evaluate the ECG pattern
continually for dysrhythmia.
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* Wash hands.
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Procedure
Ongoing Care
Checks the alarm limit settings at the
start of every shift and continues to
adjust the alarm as the patient’s
rhythm and condition warrant.
Reviews every shift the monitoring
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trends and alarms.
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Procedure
Ongoing Care
Reassess the patient for signs of
hemodynamic compromise with any
significant changes in cardiac rate or
rhythm (i.e. BP, oxygen saturation,
RR, or myocardial ischemia).
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Procedure
Ongoing Care
Reports to the physician:
• Life threatening cardiac arrhythmias
and initiates appropriate actions.
• New or unexpected changes in the
cardiac rate, rhythm or clinical
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status.
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Procedure
4. Documentation
*Record the patient’s ECG.
*Record any dysrhythmia and
treatment.
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Special Considerations
Make sure all electrical equipment and outlets
are grounded.
Ensure that the patient is clean and dry.
Avoid opening the electrode packages until just
before using.
Avoid placing the electrodes on bony
prominences, hairy locations, areas where
defibrillator pads will be placed, or areas for
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chest compression.
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Special Considerations
If the patient’s skin is very oily, scaly, or
diaphoretic, rub the electrode site with a dry
gauze pad before applying the electrode.
Have the patient breathe normally during the
procedure.
Assess skin integrity, and reposition the
electrodes every 48 hours.
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Reference
• Cardiac Monitoring – Faculty of Nursing
Mansoura University
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