Transcript Electrocardiography for Health Care Personnel - FTC

12.1 What Is Ambulatory Monitoring?
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Process of recording an ECG tracing while the
patient goes about daily activities
Typical ambulatory monitor is a small box strapped to
the waist or shoulder for 24 to 48 hours
Inside the box is a recording
device
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12.1 What Is Ambulatory Monitoring?
(Cont’d)
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One type is the Holter
monitor, named after
Norman Holter
Three to five leads are
attached, depending on
monitor type
Patient keeps diary of
activities, recording
symptoms and abnormal
sensations
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12.1 What Is Ambulatory Monitoring?
(Cont’d)
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Computer is used to view, print, and analyze tracing from
monitor
Cardiologist usually performs final interpretation of results
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12.2 How Is Ambulatory Monitoring
Used?
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To capture abnormal heart rhythms when symptoms do
not occur during 12-lead or stress ECGs
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To monitor effectiveness of cardiac medications
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To evaluate pacemaker function
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To evaluate the heart after a recent myocardial infarction
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12.3 Variations of Ambulatory
Monitoring
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Continuous monitoring
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Intermittent monitoring
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Telemetry
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Transtelephonic monitoring
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12.3 Continuous Monitoring
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Complete tracing from time unit is applied until removal
Patient can activate “event marker”
 Traces the exact time symptoms occur
Unit is equipped with a clock to correlate tracings with
diary entries
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12.3 Intermittent Monitoring
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Patient activates recording only when symptoms occur
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Only shows ECG tracing during the symptom
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Can be evaluated more quickly than continuous
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12.3 Telemetry Monitoring
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Performed inside medical facility
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Uses three or five electrodes on chest
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Transmits to a central location where multiple patients
may be monitored
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Patient diary not required
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12.3 Transtelephonic Monitoring
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Primarily used to evaluate pacemaker function
Can be used for monitoring patients longer than 24 to
48 hrs
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12.3 Transtelephonic Monitoring
(Cont’d)
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Information is stored in the monitor, then transmitted
via telephone
2 types: post-symptom event and loop memory
monitor
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12.3 Post-Symptom Event Monitor
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Used when patient is experiencing symptoms
Can be worn like a wristwatch or be hand-held
Handheld type is placed against chest when
experiencing symptoms
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Post-Symptom Event Monitor (Cont’d)
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Wristwatch type is worn at all times
Used to document dysrhythmias that last more than
a few seconds
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12.3 Loop-memory Monitor
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May remain on chest for 30 days or more
Memory on monitor can hold up to five minutes
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12. 3 Loop-memory Monitor (Cont’d)
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Provides physician with recording before, during,
and after event, such as fainting
New monitors have capability of a 12-lead ECG
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12.3 Troubleshooting:
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Instruct patient to press in center of loose electrode to
reapply and to return to facility if electrode falls off
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Ambulatory monitors are sensitive and expensive;
avoid dropping
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12.4 Educating the Patient
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Diary
A
record of events and symptoms that occur while
monitor is in place
 Used
in conjunction with ECG tracing
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Have patient repeat diary instructions
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Remind patient of any medication changes
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12.4 Diary – What Is Recorded
All usual and unusual activities, such as:
 Urinating, bowel movements
 Sexual activity
 Walking
 Emotional upset
 Eating
 Sleeping
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12.4 Law and Ethics
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It is your responsibility to remind the patient of
medication changes prescribed by the physician
For questions regarding indications, side effects, and
precautions of medications, refer the patient to the
licensed practitioner
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12.4 What the Patient Should Know
During Ambulatory Monitoring
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Wear loose fitting clothing for comfort and to reduce
artifact
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Sponge baths are allowed; no showers or tub baths
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When sleeping, make sure tension is not applied to
leads
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12.4 What the Patient Should Know
During Ambulatory Monitoring (Cont’d)
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Avoid magnets, metal detectors, high-voltage areas,
and electric blankets
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Check monitoring equipment for proper functioning
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Patient education should be written in the patient’s chart
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12.4 Patient Education and
Communication
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Have patients tell you what they already know about
ambulatory monitoring, then explain to them what
they don’t know
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Explaining the procedure and answering questions
should alleviate patient fears
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12.5 Ambulatory Monitoring for
Children
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Consider child’s age and use terms he or she can
understand
Allow the child to touch the equipment prior to
applying it
Remember to instruct parent as well
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12.6 Before the Procedure: Gather
Equipment
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Monitor with holder and strap or belt
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Batteries and tape or disk
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Electrodes (3 or 5)
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Lead wires
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Alcohol and gauze
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Patient diary
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12.6 Before the Procedure: Gather
Equipment (Cont’d)
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Skin preparation materials
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Shaving equipment
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Tape
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Patient education checklist
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Manufacturer’s directions for monitor
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Pen
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12.6 Before the Procedure
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Prepare monitor and
review instructions
Check monitor charge
Insert blank tape or disk if
required
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12.6 Prepare the Patient
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Clothing should be removed from waist up
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Provide drape
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Have patient sit or lie down and relax
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Dry shave electrode sites, if necessary (clip hair for
telemetry monitoring)
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12.6 Place the Electrodes
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Use alcohol swab and let dry
Abrade skin
Follow manufacturer’s
instructions for electrode
placement
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12.6 Elderly or Patients on Certain
Medications
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Apply less pressure when abrading skin
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Avoid abrasive cleansers
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Use caution when applying and removing electrodes
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12.6 Applying the Monitor
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Attach lead wires to electrodes
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Arrange lead wires comfortably on patient
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Tape each electrode in place
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Attach cable to electrocardiograph and run baseline
ECG
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12.6 Applying the Monitor (Cont’d)
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Have patient dress, then attach cable to monitor
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Check lead wires and electrodes
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Start monitor, have patient make first diary entry
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Review all patient instructions
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12.6 Applying the Monitor (Cont’d)
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When applying an unfamiliar type of monitor,
follow manufacturer’s directions
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If directions are unavailable, consult supervisor
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12.7 Removing the Ambulatory
Monitor
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Review patient’s diary
Turn off monitor and detach lead wires
Detach lead wires and cable from patient
Remove tape and electrodes
Clean skin
Record removal procedure on patient’s chart
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12.7 Reporting Results
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Follow manufacturer’s instructions for preparing
recording for evaluation
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Final interpretation may be done by a physician, usually
a cardiologist within your facility, or sent to an outside
laboratory
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12.7 Reporting Results (Cont’d)
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Ensure cassette or results are properly labeled,
including:
 Patient’s name
 Medical record number
 Date
 Physician’s name
Patient diary must be kept with cassette or results
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12.7 Reporting Results (Cont’d)
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Factors affecting accuracy of tracing results:
 Improper lead attachment
 Incomplete patient diary
 Failure of patient to maintain normal routine
If results are sent to an outside lab, report can take
seven to ten days
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12.7 Abnormal Results
Abnormal results may indicate:
 Electrical conduction defects in heart’s rate and rhythm
controlling system
 Rhythm abnormalities
 Premature atrial or ventricular contractions
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12.7 Abnormal Results (Cont’d)
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Additional testing that may be required:
 Echocardiogram
 Coronary angiogram
 CT (computerized tomography) scan
 MRI (magnetic resonance imaging)
 PET (position emission tomography) scan
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