Cardiac monitoring

Question 1

Equipment

Answer 1

• Cardiac monitor
• Electrodes
• Wipes
• Cardiac monitor leads
• Alcohol gel

Question 2

Performance of task

Answer 2

• Gather equipment
• Draw curtains
• Wash hands
• Request that patient removes clothing from upper half of body (bra can stay)
• Ensure patient is lying in supine position (state)
• Ensure skin in dry and may need to shave some (state)
• Clean sites (state)
• Apply electrodes accurately and smooth down the adhesive
  rather than the central gel disc. Pressure on the gel disc can decrease conductivity and adherence. ON DIAGRAM
• Connect the monitor leads to the electrodes ON PATIENT
• Switch monitor on
• Select required monitoring lead (usually II)
• Obtain trace and check for abnormalities
• Set alarms to safe parameters (Do! 10-20 above and below patient’s heart rate - work out from pulse)

Question 3

After the procedure

Answer 3

• Secure leads so they don’t tug (state)

- Record that cardiac monitoring has started, time and rhythm

Question 4

Aftercare

Answer 4

• State that you would position the monitor so it is visible to staff
• State you would check welfare
• Check the electrode sites regularly for any redness or itching - if so/skin looks inflamed, the electrodes
  may need to be removed and placed at a different site.

Question 5

What would you say to inform the patient about cardiac monitoring?

Answer 5

‘This cardiac monitor will continually measure the rate of your heart. I am going to attach 3 stickers to your chest, these will then attach to some leads which will attach to a monitor. Then we can monitor the trace of your heart. This will remain on for the rest of the day - you don’t have to stay still but if you need to get up and go to the toilet just let us know. If your rate increases then there will be a little alarm that will go off which will let the nurses know. Any questions? I will need to expose your chest if that is ok? And would you like a chaperone?’

Question 6

Health and safety

Answer 6

Same as 12-lead ECG

Question 7

Where do you put the 3 electrodes?

Answer 7

Placed over bone where possible (stops muscular electrical interference):
- Red - Right shoulder (over acromion / lateral clavicle)
- Yellow - LEft shouLder (over acromion / lateral clavicle)
- Green - Lower left chest wall (over ribs)(apex of heart)
The leads from these electrodes terminate in one cable which is plugged into the machine.

Question 8

Troubleshoot - Flatline ECG trace

Answer 8

Check carefully to ensure the patient has not had a cardiac arrest.
If patient’s condition is unchanged:
Ensure the most appropriate lead has been selected – usually Lead II.
Check the gain (the size of the QRS complex) on the monitor; it may need to be
increased.
Check all the connections between the leads and the electrodes, and to the monitor

Question 9

Troubleshoot - Poor quality trace

Answer 9

Check all connections.
Check the brightness on the display.
Make sure the electrodes are in date and still moist.
Ensure ECG gain is set correctly.

Question 10

Troubleshoot - Wandering baseline

Answer 10

This is usually caused by patient movement.

If patient has a tremor, is anxious or cold, try and reassure them and keep them warm.

Question 11

Troubleshoot - Electrical interference

Answer 11

If possible, remove any other bedside equipment causing interference

Question 12

Complications

Answer 12

Redness/itching at site of electrodes

Question 13

Allergies

Answer 13

Could ask if allergic to ‘sticking plasters or anything like that’