All CCTC patients have continuous
ECG monitoring, unless otherwise ordered. Change ECG electrodes
OD during bath, and prn.
ECG1 (the first waveform display) must be
setup to monitor Lead I, II or a V Lead when using the Datex monitors.
Select the lead that provides the tallest QRS complex.
To provide continuous monitoring with prompt detection of changes
in heart rate or rhythm.
Electrodes are changed to maintain optimal contact.
The Datex monitors require Lead I, II or a V lead in ECG1.
ECG alarms must be appropriately set and
turned on at all times. High and low alarm settings are assessed
and documented each hour in the graphic record.
Alarm settings are selected based on the
degree of fluctuation in the patient's HR. Upper and lower alarm
limits that represent clinically important changes are selected
for each individual patient.
Alarms may be disabled during withdrawal-of-life-support.
On occasion, efforts to resolve nuisance alarms may not be successful.
If ECG alarms are disabled, documentation in the AI record is required.
Documentation should include the reason for disabling the alarm
and troubleshooting strategies.
If HR monitoring from the ECG is not possible, change the monitor
to enable heart rate monitoring from the arterial line.
Alarm limits are confirmed and documented in the graphic record as shown below.
To promptly detect relevant changes.
To eliminate nuissance arrhythmia alarms, turn
the arrhythmia alarms to "severe". This will limit the
arrhythmia detection to lethal arrhythmias. If frequent PVCs are
being detected, turn the PVC alarm off.
Prep skin by washing with water and drying well. Trim hair. Do
not shave the skin or use alcohol or detergents. Roughen skin up
with sandpaper prior to electrode placement to improve skin contact
(available in tape dispensers). Connect lead to electrode before
it is applied to the skin (avoid pressing electrode onto skin; this
may cause loss of contact gel).
The QRS height must be 1/2 the height of the white calibration
marker. Increasing the gain WILL NOT improve the monitors ability
to detect the QRS. If the patient has a low QRS voltage, look at
the 12-lead ECG view and select the lead with the tallest QRS. The
Datex monitor requires Lead I, II or a V lead in ECG1. If the best
QRS height is in a different lead (e.g., lead III), the monitor
can be "fooled" by altering the leads. For example, reversing
the LL and RL leads will display the true Lead III as a Lead II.
Moving the leads closer together, or placement of an anterior
and posterior lead may increase the QRS height.
ECG Rhythm Strips
An ECG rhythm strip is collected, analyzed and posted in the clinical
record at the time of admission, at the start of each shift, q4h
if arrhythmias are present, q6h if cardiac status is stable and
prn for significant changes in the ECG rhythm for all acute patients.
HR documentation frequency may be
decreased to q shift and prn when patients become hemodynamically
stable. Chronic patients with continuous ECG monitoring and stable
rhythms require OD and prn ECG rhythm documentation.
To document ECG rhythm.