Groundwork
Explain and discuss the procedure
with the patient to gain consent and co-operation for the procedure. Explain to the patient the need for bed rest during monitoring, and ensure privacy and dignity.
Equipment required:
- Cardiac monitor with leads (ensure a maintenance sticker is present to show that the equipment is safe to use)
- Disposable electrodes
- Disposable razor or clippers (if required, to remove chest hair)
Usual infection control policies
apply, e.g. handwashing. Special precautions may be required depending
on patients condition, e.g. MRSA.
Procedure
- Place the monitor on a firm flat surface, near and electrical socket and away from liquids, i.e. patients drinks.
- Raise the bed to a suitable working height(remember moving and handling).
- Expose patient's chest and examine sites where electrodes will be place, maintain dignity.
- If patients chest is very hairy, a small patch of hair needs to be removed using razor/clippers to allow good contact of the electrodes.
- Examine electrodes, check expiry date and ensure electrodes have not dried out.
- Remove the backing paper from the electrode, stick the electrode firmly to the chest wall, whilst avoiding touching the gel in the middle.
- Connect the leads to the electrodes. The leads are labelled or coloured and are connected(image a).
- Turn on monitor and select lead II, this should produce the most positive display. If it is not displaying properly try lead I or Lead II. Adjust display size to suit.
Post Procedure
Explain to the patient and demonstrate if necessary what happens if the patient moves as this produces abnormal patters and may cause undue concern to the medical staff. Lower the bed, for patient safety. Electrodes can be left in situ for several day, but may need replace more often if patient is sweaty, electrode dries out, or if patients skin shows signs of irritation. Note the rhythm show on the monitor and take a printout (if able). Any abnormalities should be brought to the attention of the appropriate personnel and documented.
Notes
In acute settings, most patients on cardiac monitoring are required to rest in bed. However, if the patient is undergoing investigations for cardiac rhythm abnormalities they will normally be placed on telemetry, in this case the patient is allowed to move around, although they should always inform the nurse where they are going. The leads are referred to as limb leads even though they are attached to the chest. This is because they represent that part of the body.
References
Bavin, C., Bedford-Turner, S., Cronin, P., Nicol, M. and Rawlings-Anderson, K. (2002) Essential Nursing Skills. Edinburgh: Mosby.
Baxter, A., Dolan, S. and Gale, N. (2001) Observations. In: Dougherty, L. and Mallet, J. (eds.) The Royal Marsden Hospital: Manual of Clinical Nursing Procedures. 5th Edn. London: Blackwell Science.
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