R-

I TO
O N N G
C M I
DIA
CAR
AHAMMED NASEEM
3rd YEAR BSC NURSING
ALMAS COLLEGE OF NURSING
DEFINITION

 Cardiac monitor is a device that shows the electrical

activity and pressure wave form of cardiovascular sys-
tem for measurement and treatment .
 Parameters specific to respiratory system also be
measured
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 de-
partment
 Continuous cardiac monitoring help for prompt identi-
fication and initiation of treatment for cardiac arry-
thmias 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
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
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
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
 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-mit-
ter
 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
EQUIPMENT REQUIRED

 Cardiac monitor
 Cardiac table
 Pressure transducer and BP cuff

 ECG leads and electrodes

 SPO2 probe
 Alcohol/ dry gauze

 Temperature probe
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
 Expose the site for SPO2 probe, temperature
probe and chest leads
 Rub the selected site using washcloth or gauze
pad 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
 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
ELECTRODE PLACEMENT SITES
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
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
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
applied using hypoallergic electrode if necessary