PROCEDURE FOR CONTINUOUS 12 LEAD MONITORING WITH DATEX MONITORING SYSTEMS

  1. Select Patient
  2. Obtain Equipment
  3. Hand Hygiene
  4. Prepare Patient
  5. Hooking up to Datex Monitor
  6. Obtain 12 Lead
  1. Notify Physician
  2. Documentation

PROCEDURE

RATIONALE FOR PROCEDURE

 1.

Select Patient

Criteria for patients utilizing continuous 12 lead monitoring;

  • known ischemia
  • suspected ischemia
  • arrhythmias

 

 1.

To ensure resources are used on appropriate patients and applied consistently.

 2.

Obtain Equipment

Obtain module,green cable and 6 extra lead wires in Bay 3 equipment room in bin marked "ECG monitoring." Obtain additional electrodes.

 2.

12 lead ECG

 3.

Hand Hygiene

Perform hand hygiene.

Explain procedure to patient.

 3.

In accordance with the MoHLTC 4 moments of hand hygiene and LHSC infection control policies in an effort to reduce risk of transmission of microorganisms and secretions.

    4.

Prepare Patient

Cleanse the area for application of electrodes with soap and water and dry thoroughly. Consider using alcohol to remove oils from skin.

Abrade the skin with gauze.

Leads can be placed by RN according to standard placement guidelines (diagram is available on the cable). Electrodes must be applied securely.

Perform hand hygiene.

 

 

       4.

Provides for adequate transmission of electrical impulses. Moist skin is not conducive to electrode adherence. It may be necessary to clip chest hair to ensure good skin contact with the electrode.

Removes dead skin cells, promoting impulse transmission.

Lead placement must be standard to avoid errors in ECG interpretation caused by incorrect lead placement.

 5.

Hooking up to Datex Monitor

Fasten lead wires to electrodes. Hook up green cable to lead wires and place in DatexTM TMTM(TM) module.

Select the ECG button on the Datex panel, go to "ECG View" from the submenu and ensure all leads are viewed, then select print page.

 5.

Electrodes must be secure to prevent external influences from affecting the ECG.

 6.

Obtain 12 lead

Print off a 12 lead for the following situations;

  • a baseline 12 lead
  • with onset of narrow or wide complex tachycardias
  • with chest pain or suspected chest pain
  • change in ST segments or there is a change in the ECG rhythm that is significant

The 12 lead monitoring system does not replace a 12 lead ECG performed by the ECG technician. If a 12 lead ECG view of the posterior/right sided leads is needed, call the ECG tech to come and perform this.

 6.

A baseline ECG provides a template of patient's baseline rhythm to compare when changes occur and evaluate if treatment is necessary.

  

 

Placement of posterior/right sided electrodes is not a common skill for staff and may be difficult for staff to maintain competency in proper placement of electrodes.

 7.

Notify Physician

The RN is responsible for notifying the CCTC physician of the completed 12 lead ECG and if changes occur.

 7.

Notifying the CCTC physician allows for further evaluation and interpretation of the 12 lead ECG and if necessary obtain orders for treatment.

8.

Documentation

Record on the A & I sheet the time and reason for continuous 12 lead and any siginificant events that occur, along with physician notified and if any treatment was performed.

 8.

It is the RN's responsiblity to notify the physician with ECG changes and document findings and orders obtained.

References:

User's reference manual from Datex Ohmeda Critical Care Monitor (2000).

McKinley, M.G.(2005). AACN's Procedure Manual for Critical Care (5th edition)Elsevier Saunders: St.Louis, Missouri.

ICU procedure developed by Rachelle McCready and Cathy Mawdsley (2004).


Developed by: Gina Souliere RN, BScN

April 21, 2010.


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LHSCHealth Professionals

Last Updated April 21, 2010 | © 2007, LHSC, London Ontario Canada