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Abstract
Continuous monitoring of the electrocardiogram (ECG) is a common intervention performed by cardiac nurses. In the first article of this two-part series, we evaluated the principal indications for ECG monitoring; these are the detection of arrhythmias, monitoring for myocardial ischaemia, and measurement of the QT interval. In this second article, the practical issues surrounding ECG monitoring are evaluated. The use of 3- and 5-electrode systems is discussed, and related to ECG theory and normal coronary artery anatomy. Recommendations are made for lead selection, correct electrode placement, and the recording of 12-lead ECGs. The current article concludes with a consideration of safe practice with respect to alarm management, and considers both individual and organisational approaches to reducing inappropriate alarms.
Highlights
Continuous monitoring of the electrocardiogram (ECG) is a common intervention performed by cardiac nurses
We evaluated the principal indications for ECG monitoring
These are the detection of arrhythmias, monitoring for myocardial ischaemia, and measurement of the QT interval
Summary
Continuous monitoring of the electrocardiogram (ECG) is a common intervention performed by cardiac nurses. Continuous monitoring of all 12 ECG leads is possible, and is performed on some units, in many clinical areas only one or two leads are constantly evaluated This reduces the number of electrodes that must be placed on the patient, as well as the complexity of the monitoring equipment required. If a change in rhythm is detected during monitoring, and time allows (i.e. the patient is not in cardiac arrest or close to it), a 12-lead ECG should be recorded using standard electrode positions (Pitcher and Nolan, 2015). This ensures documentation of the arrhythmia, and may be helpful for rhythm interpretation. Training is recommended to ensure that clinicians are familiar with monitoring equipment, and know how to adjust and troubleshoot alarms (AACCN, 2013)
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