2. DEFINITION
Cardiac monitor is a device that shows the electrical a
ctivity and pressure wave form of cardiovascular syste
m for measurement and treatment .
Parameters specific to respiratory system also be
measured
3. PURPOSES
Continuously monitor cardiac rhythm, heart rate, BP,
respiratory rate, SPO2 and also temperature
Used for continuous observation of critically ill patients
in emergency department as well as critical care
department
Continuous cardiac monitoring help for prompt
identification and initiation of treatment for cardiac
arrythmias and other conditions that affect on
respiratory or cardiovascular system
It is useful for observation of post-operative patients,
patient with severe electrolyte imbalances and other
unstable patients
4. INDICATIONS
Chest pain
Palpitation
Acute coronary syndrom {STEMI, NSTEMI , Unstable angina}
Following major surgeries especially cardiac and neuro
surgeries
Major trauma
Post cardiac or respiratory arrest
Acute medical conditions such as pulmonary embolus,
drug overdose, electrolyte imbalances etc
Unexplained syncope
Shock
unconscious patients
Critically ill patients
5. FUNCTIONS OF CARDIAC MONITOR
Continuous monitoring of vital signs and cardiac and
pulmonary rhythm along with ECG
Alert when patients vital signs are going above or
belove of pre-set values
Provide rhythm strip to document evidence of
arrythmias
6. BASIC FEATURES OF CARDIAC MONITOR
STATIC BEDSIDE CARDIAC MONITOR SYSTEM
ECG detected from patient electrode and transmitted to
monitor via monitor lead cable
Display ECG rhythm continuously
ECG may duplicated to a central console monitoring
system
Some system incorporated computerized software to
recognize life threatening cardiac arrythmias and alert
7.
8. TELEMETRY MONITORING
Portable wireless cardiac monitoring system
Allow transmission of the ECG without requiring
the patient to be attached to a static monitor
A patient standard chest electrodes and leads
are connected to small portable monitor trans-mitt
er
Cardiac rhythm is transmitted to receiver unit at
central monitoring station where the rhythm is
displayed continuously
Suitable for ambulatory cardiac patients requiring
ongoing ECG monitoring
9.
10. EQUIPMENT REQUIRED
Cardiac monitor
Cardiac table
Pressure transducer and BP cuff
ECG leads and electrodes
SPO2 probe
Alcohol/ dry gauze
Temperature probe
11. PROCEDURE
All electrical equipment are grounded to avoid electrical
shock and artifact
Turn on monitor and connect the cables to the monitor
(if not already attached) according to colour code or
instruction by the manufacturer
Open the electrode package and attach an electrode to
each lead wire
Explain the procedure to patient and bystander and obtain
consent
Wash hands and , provide privacy to the patient and
ensure that patient is in clean and dry place to avoid
electrical shock
12. Expose the site for SPO2 probe, temperature
probe and chest leads
Rub the selected site using washcloth or gauze p
ad briskly until it turn to redden but care should
be taken to avoid damage to the skin
Death skin cells are removed in this manner there by
promote better electrical conduction
Patient who are extremely hairy may need to be
shaved prior to application of electrode
An alcohol pad is used to clean the site
Area should be completely dry before applying
electrode alcohol shouldn’t trapped beneath the
electrode it may leads to skin breakdown
Place electrodes in appropriate position the each
side of electrode is pushed against the skin and
pull gently to ensure it is properly attached,
repeat over every electrodes
13. Should press two fingers on electrode in a circular
pattern to affix the gel and stabilize the electrode
then repeat on each electrode
To avoid the potential artifact don’t place electrode
over bony prominence or hairy areas
Place SPO2 probe on finger
Place temperature probe according to hospital
policy
Place BP cuff connected to the monitor on upper
arm
15. AFTER CARE
After placing all electrodes observe the monitor and evaluate
the quality of tracing , making size and position adjustment
as needed
Should confirm that the monitor is detecting each heart beat
by taking apical pulse and compare it with monitor reading
The upper and lower alarm of each vitals are set according
to hospital policy and activate the alarm
A rhythm strip should be recorded for medical record and
label with patient’s name, age, hospital ID along with date
and time
16. NURSES RESPONSIBILITY
Asses patients condition and need for cardiac monitoring
If indicated explain the procedure and obtain informed
consent
Obtain all equipment needed and arrange at bedside
Ensure that all electrical equipment are grounded
Explain the procedure to the bystander and ask the patient
to relax
Do the procedure
Confirm the monitor detecting each heart beats by taking
apical pulse and compare it with monitor readings
Evaluate the quality of tracing of electrodes and make
adjustments as needed
17. COMPLICATIONS
Potential risk for electrolyte imbalances
Potential risk for skin breakdown at electrode placement site
Patient may allergic to adhesive used or the electrode may
have been left on the skin too long
Electrodes should be be removed and new electrodes are a
pplied using hypoallergic electrode if necessary