APPLYING A CARDIAC MONITOR

Cardiac monitoring is used for patients with conduction disturbances and for those at risk for
life-threatening arrythmias, such as post-operative patients and patients who are sedated.

EQUIPMENT:

 Lead wires
 Pregelled (gel foam) electrodes (number varies from 3 to 5)
 Alcohol pads
 Patient cable for hardwire cardiac monitor
 Transmitter, transmitter pouch, and telemetry battery pack for telemetry
 PPE, as indicated.

PROCEDURE:

1. Verify the order for cardiac monitoring on the patient’s medical record.
2. Gather all equipment and bring to bedside.
3. Perform hand hygiene and put on PPE, if indicated.
4. Identify the patient.
5. Close curtains around bed and close the door to the room, if possible. Explain the procedure to
the patient. Tell the patient that the monitoring records the heart’s electrical activity. Emphasize
that no electrical current will enter his or her body. Ask the patient about allergies to adhesive,
as appropriate.
6. For hardwire monitoring, plug the cardiac monitor into an electrical outlet and turn it on to warm
up the unit while preparing the equipment and the patient. For telemetry monitoring, insert a
new battery into the transmitter. Match the poles on the battery with the polar markings on the
transmitter case. Press the button at the top of the unit, test the unit to ensure that the battery
is operational.
7. Insert the cable into the appropriate socket in the monitor.
8. Connect the lead wires to the cable. In some systems, the lead wires are permanently secured
to the cable. For telemetry, if the lead wires are not permanently affixed to the telemetry unit,
attach them securely. If they must be attached individually, connect each one of the correct
outlet.
9. Connect an electrode to each of the lead wires, carefully checking that each lead wire is in its
correct outlet.
10. If the bed is adjustable, raise it to comfortable working height, usually elbow height of the
caregiver.
11. Expose the patient’s chest and determine electrode positions, based on which system and
leads are being used. If necessary, clip the hair from an area about 10cm in diameter around
each electrode site. Clean the area with soap and water and dry it completely to remove skin
secretions that may interfere with electrode function.
12. Remove the backing from the pregelled electrode. Check the gel for moistness. If the gel is
dry, discard it and replace it with a fresh electrode. Apply the electrode to the site and press
firmly to ensure a tight seal. Repeat with remaining electrodes to complete the three-lead or
five lead system.
13. When all the electrodes are in place, connect the appropriate lead wire to each electrode.
Check waveform for clarity, position, and size. To verify that the monitor is detecting each beat,
compare the digital heart rate display with an auscultated count of the patient’s heart rate. If
necessary, use the gain control to adjust the size of the rhythm tracing, and use the position
control to adjust the waveform position on the monitor.
14. Set the upper and lower limits of the rate alarm, based on the patient’s condition or unit policy.
15. For telemetry, place the transmitter in the pouch in the hospital gown. If not available in gown,
use a portable pouch. Tie the pouch strings around the patient’s neck and waist, making sure
that the pouch fits snugly without causing discomfort. If no pouch is available, place the
transmitter in the patient’s bathrobe pocket.
16. To obtain a rhythm strip, press the RECORD key either at the bedside for monitoring or at the
central station for telemetry. Label the strip with the patient’s name and room number, date,
time, and rhythm identification. Analyze the strips, as appropriate. Place the rhythm strip in the
appropriate location in the patient’s chart.
17. Return the patient to a comfortable position. Lower bed height and adjust head of bed to a
comfortable position.
18. Remove the additional PPE, if used. Perform hand hygiene.