|
Procedure for ST segment monitoring with Datex
monitors
All patients in the
ICU/EICU will have ST segment monitoring; alarms may be left off at the
nurses discretion; HOWEVER: the ST alarms MUST be on in the following cases:
a) pt has
chest pain;
b) ALL cardiac
surgery patients
c) ALL MI patients
|
Procedure |
|
Rationale |
| 1. |
Alarm
defaults will be set to detect an ST segment elevation of +2 mm.This may
be adjusted according to pt. condition. |
1. |
This
is the default set by the manufacturer. The default can be changed based
on the patient's condition. |
| 2. |
Changes
to defaults (eg increasing elevation default from +2 with pericarditis
etc) should be documented on the ICU flowsheet as well as the Kardex.
If you are increasing the default because of new ST elevation, obtain
a 12 lead and notify the MD. |
2. |
Changes
need to be documented to allow information to be passed on to team members.
|
| 3. |
Patient
must be supine to establish baseline "picture" of ST segments |
3. |
|
| 4. |
Audible
alarms and territory alarms will be defaulted to "off"; with your initial
assessment, determine the need(according to pt condition) for the alarms
to be on/off and activate alarms as needed.
Alarms
that are usually on may be turned off for mobilizing patients and patinet
transfer. |
4. |
|
| 5. |
Select
the ECG leads to be displayed on the monitor specific to the areas of the
heart at risk for ischemia:
-
RCA:
lead II or III
-
LCA:
lead V2 or V3
| NOTE: ST segments may be falsely elevated due to electrolyte imbalances,
changes in patient position, hyperventilation, changes in lead placement,
etc. |
|
5. |
|
| 6. |
To
View ST Segments
To
change the ECG ‘User’ leads viewed on the monitor/and the user ST
segments being monitored the following needs to be done:
1.
Depress the ECG key.
2.
Select one of the ECG 1, ECG 2, or ECG 3 options.
3.
When selected another menu appears, select desired lead.
4.
Press to confirm choice. The desired lead will now be viewed on the monitor,
and is one of the user ST segments being displayed on the ST digital display.
To
view and print ST analysis:
1.
Depress ‘ECG’
2.
Select ‘ST View’
3.
Select ‘Print QRS/ST’
(At
this time the page viewed as well as a page of ST trends will be printed.)
To
manually save new QRS reference:
1.
While in the ‘ST View’ screen select ‘Save new QRS’. This will create
a new QRS as reference. A total of 6 references is possible to be saved
by the user.
To
erase a saved QRS:
1.While
in the ‘ST View’ screen select ‘Erase QRS’
2.
Press the ‘Erase QRS’ option and scroll through options of saved QRS to
select the desired one to be erased.
3.
Press when desired QRS is seen. It will be erased.
4.
Please note that the initial QRS that is saved by the monitor cannot be
erased.
To
view Reference QRS that have been saved:
1.
While in the ‘ST View’ screen select ‘Reference QRS’
2.
Press the ‘Reference QRS’ option and scroll through options of QRS saved.
For each option press to view.
To
View ST Trends:
1.
In the ‘ST View’ screen select ‘ST Trends’
2.
Under the ‘Leads’ option select desired lead view, by pressing on the option
and scrolling through.
3.
The time scale of the trend view may also be selected under the ‘Time scale’
option. Time scale of 30 min to 72 hrs is available.
|
|
|
| 7. |
Documentation:
a)
ST alarm activation and changes to limits must be documented on the ICU
flowsheet as well as the Kardex.
b)
on initial assessment, document ST values in the assessment section of
the flowsheet |
|
|
References
Drew,
B. ( ). Bedside ECG monitoring. AACN Clinical
Issues. 25-33.
Drew
& Krucoff (1999). Multi-lead ST segment monitoring in patients
with acute coronary syndromes: A consensus statement for health care professionals.
American Journal of Critical Care, 8(6), 372-386.
Drew
& Sparacino. (1991). Accuracy of bedside ECG monitoring: A report
on current practices of critical care nurses. Heart Lung 20(6), 597-608.
Drew,
Pelter, Adams, Wung, Chou, and Wolfe. (2998). 12 Lead ST Segment
moniotring versus single lead maximum ST segmentn monitoring for detecting
ongoing ischemia in patients with unstable coronary syndromes. American
Journal of Critical Care, 7(5), 355-60.
Leeper.
B. (Sept, 2001). ST segment monitoring across the continuium.
AACN News. American Association of Critical Care Nurses.
|
Print
Handheld
Contrast
