Nursing Interventions for Inpatient Cardiac Monitoring PDF

1/9/24, 12:47 AM herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbusjeLUzRyumZIEGwikvZDA89aMIS3TVE3sojJO… Nursing Interventions for Inpatient Cardiac Monitoring A body of evidence indicates that most alarms occurring during inpatient ECG monitoring are false alarms....

1/9/24, 12:47 AM herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbusjeLUzRyumZIEGwikvZDA89aMIS3TVE3sojJO… Nursing Interventions for Inpatient Cardiac Monitoring A body of evidence indicates that most alarms occurring during inpatient ECG monitoring are false alarms. Nurses dealing with excessive alarms become desensitized to these sounds and develop alarm fatigue. Alarm fatigue delays response time or results in missed alarms. Several nursing interventions facilitate acquisition of accurate data, reduce risk of alarm fatigue, and ensure patient safety when using cardiac monitoring (Jepsen et al., 2018; Sandau et al., 2017). To minimize false alarms, the ECG recordings must be free of artifact, which is an abnormal ECG pattern caused by muscular activity, patient movement, electrical interference, or lead cable or electrode malfunction. Artifact can mimic arrhythmias and cause unnecessary false alarms. Key to the elimination of artifact is using proper skin preparation before applying electrodes and changing the electrodes every 24 hours. During electrode changes, the skin should be assessed for allergic responses (itchy, reddened skin) to the adhesive or electrode gel. If present, the electrodes are replaced with hypoallergenic electrodes. Rotation of electrode placement on the skin will reduce the risk for skin breakdown. Electrodes and lead connections need to be positioned correctly. Improper positioning can result in artifact that mimics ischemia or arrhythmias. Two leads should be selected that provide the best tracing for arrhythmia monitoring, which are usually lead II and the chest lead V1. Electrical equipment in use around the patient should be inspected to be certain that it is functioning properly and has been recently checked by the medical engineering department per organization policy, because improperly functioning equipment may cause false alarms from artifact. An effort should be made to individualize the ECG alarm parameters to meet the patient’s monitoring needs. For example, if the patient has atrial fibrillation, it is appropriate to turn off the irregular heart rate alarm. Keeping it on will create unnecessary alarms, contributing to alarm fatigue. Similarly, the bradycardia and tachycardia alarms should be adjusted, slightly below or above the patient’s underlying heart rate (Jepsen et al., 2018; Sandau et al., 2017). The nurse’s role is to respond to and correct all monitor alarms immediately. Inoperative (inop) monitoring alarms—used to communicate that electrodes have fallen off, that leads are loose, or that the system’s battery power is low (e.g., telemetry)—are just as significant as arrhythmia alarms indicating that the patient is tachycardic, bradycardic, or experiencing another potentially lifethreatening arrhythmia. Timely responses to all alarms can prevent serious consequences, including death. Hospital-acquired infections can be transmitted through lead wire cables. This may be prevented by using disposable lead wire cables, or by keeping reusable cables and transmitter equipment clean, https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbusjeLUzRyumZIEGwikvZDA89aMIS3TVE3sojJO9aojXmGqF3r… 1/3 1/9/24, 12:47 AM herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbusjeLUzRyumZIEGwikvZDA89aMIS3TVE3sojJO… per organizational policy. A patient should never be connected to monitoring equipment that has not been thoroughly cleaned between patients. If a patient is scheduled for a device implant, such as a pacemaker, electrodes should not be placed over the planned incision site. Likewise, electrodes should never be placed over an incision, implanted device, open wounds, or inflamed skin. Electrodes should be removed once monitoring is discontinued and skin cleansed to remove excess electrode gel and adhesive. Metal-containing electrodes must be removed before sending a patient for any magnetic resonance scan, including magnetic resonance angiography (MRA). Telemetry transmitters and other monitoring equipment should be maintained according to the manufacturer’s recommendations. Monitoring devices of any type should not be submerged in water. A monitoring device may break if dropped; therefore, it should be secured to the patient’s gown or clothing. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbusjeLUzRyumZIEGwikvZDA89aMIS3TVE3sojJO9aojXmGqF3r… 2/3 1/9/24, 12:47 AM herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbusjeLUzRyumZIEGwikvZDA89aMIS3TVE3sojJO… https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbusjeLUzRyumZIEGwikvZDA89aMIS3TVE3sojJO9aojXmGqF3r… 3/3