CHART 383

Procedure for Continuous ECG Monitoring

Choose an area to place the electrodes where there are no bony prominences, thick muscles, or skin folds, because these areas are prone to produce noncardiac waveforms and interference. Prepare the skin for electrode placement by making sure that it is clean, dry, and free of hair. It may be necessary to shave the chest area of male patients. Remove dead skin cells to improve electrical conductivity by rubbing the skin with the rough patch on the back of the electrode, a dry washcloth, or a gauze pad. The skin will become reddened with the rubbing; be careful not to cause skin breakdown. Wipe the skin with an alcohol sponge if skin is oily or a moist wipe; allow it to air dry. Make sure that the electrode pads are moistened with conducting gel prior to placing them on the chest to increase electrical conductivity. A dry electrode is not effective for conducting the electrical activity. When the electrode becomes dry or loose, it needs to be replaced. If the skin around the electrode becomes irritated the electrode must be removed and relocated. Position electrodes on the chest wall at prescribed locations depending on the lead or leads being monitored. Change electrodes when wet, poor contact, unclear tracing, and/or every 48 hours to avoid skin irritation.

Electrode Attachment

Lead Wire and Cable Connection

Connect the electrode to the lead wire, which is approximately 16 inches long. Typically a snap attaches the lead wire to the electrode. The lead wires are color coded to represent positive, negative, and ground leads. Attach the opposite end of the lead wire to the cable. The cable has individual color-coded receptacles or holes for each lead wire.

Monitor Connection and Adjustment

Attach the cable to the monitor. Adjust the monitor to increase the size of the PQRST complex for more accurate interpretation. Read the operating instructions for the specific brand of monitor prior to use. Always leave the alarm on. Recognize that the alarms have upper and lower heart rate limits. Set the alarm approximately 20 beats above and below the patients resting intrinsic heart rate. Follow institutional policy, if present, to determine different alarm limits. Be aware that when the alarm sounds, the first nursing responsibility is to check the patient. Recognize that movement by the patient may cause the alarm to sound falsely.

Alarm Setting

Documentation

Document lead used. Document PR interval, QRS width, QT interval, ectopic beats, and type of rhythm/dysrhythmia. Record ECG changes and patients response to changes.