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1
Process of recording an ECG tracing while the patient goes about daily activities
Typical ambulatory monitor is a small box strapped to the waist or shoulder for 24 to 48 hours
Inside the box is a recording
device
12.1 What Is Ambulatory Monitoring?
2
One type is the Holter monitor, named after Norman Holter
Three to five leads are attached, depending on monitor type
Patient keeps diary of activities, recording symptoms and abnormal sensations
12.1 What Is Ambulatory Monitoring? (Cont’d)
3
Computer is used to view, print, and analyze tracing from monitor
Cardiologist usually performs final interpretation of results
12.1 What Is Ambulatory Monitoring? (Cont’d)
4
To capture abnormal heart rhythms when symptoms do
not occur during 12-lead or stress ECGs
To monitor effectiveness of cardiac medications
To evaluate pacemaker function
To evaluate the heart after a recent myocardial infarction
12.2 How Is Ambulatory Monitoring Used?
5
Continuous monitoring
Intermittent monitoring
Telemetry
Transtelephonic monitoring
12.3 Variations of Ambulatory Monitoring
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Complete tracing from time unit is applied until removal Patient can activate “event marker”
Traces the exact time symptoms occur Unit is equipped with a clock to correlate tracings with
diary entries
12.3 Continuous Monitoring
7
Patient activates recording only when symptoms occur
Only shows ECG tracing during the symptom
Can be evaluated more quickly than continuous
12.3 Intermittent Monitoring
8
12.3 Telemetry Monitoring
Performed inside medical facility
Uses three or five electrodes on chest
Transmits to a central location where multiple patients
may be monitored
Patient diary not required
9
12.3 Transtelephonic Monitoring
Primarily used to evaluate pacemaker function Can be used for monitoring patients longer than 24 to
48 hrs
10
12.3 Transtelephonic Monitoring (Cont’d)
Information is stored in the monitor, then transmitted via telephone
2 types: post-symptom event and loop memory monitor
11
12.3 Post-Symptom Event Monitor Used when patient is experiencing symptoms Can be worn like a wristwatch or be hand-held Handheld type is placed against chest when
experiencing symptoms
12
Post-Symptom Event Monitor (Cont’d)
Wristwatch type is worn at all times Used to document dysrhythmias that last more than
a few seconds
13
12.3 Loop-memory Monitor May remain on chest for 30 days or more Memory on monitor can hold up to five minutes
14
12. 3 Loop-memory Monitor (Cont’d) Provides physician with recording before, during,
and after event, such as fainting New monitors have capability of a 12-lead ECG
15
Instruct patient to press in center of loose electrode to
reapply and to return to facility if electrode falls off
Ambulatory monitors are sensitive and expensive;
avoid dropping
12.3 Troubleshooting:
16
12.4 Educating the Patient Diary
A record of events and symptoms that occur while
monitor is in place
Used in conjunction with ECG tracing
Have patient repeat diary instructions
Remind patient of any medication changes
17
All usual and unusual activities, such as: Urinating, bowel movements Sexual activity Walking Emotional upset Eating Sleeping
12.4 Diary – What Is Recorded
18
It is your responsibility to remind the patient of medication changes prescribed by the physician
For questions regarding indications, side effects, and precautions of medications, refer the patient to the licensed practitioner
12.4 Law and Ethics
19
Wear loose fitting clothing for comfort and to reduce
artifact
Sponge baths are allowed; no showers or tub baths
When sleeping, make sure tension is not applied to
leads
12.4 What the Patient Should Know During Ambulatory Monitoring
20
Avoid magnets, metal detectors, high-voltage areas, and
electric blankets
Check monitoring equipment for proper functioning
Patient education should be written in the patient’s chart
12.4 What the Patient Should Know During Ambulatory Monitoring (Cont’d)
21
Have patients tell you what they already know about
ambulatory monitoring, then explain to them what
they don’t know
Explaining the procedure and answering questions
should alleviate patient fears
12.4 Patient Education and Communication
22
Consider child’s age and use terms he or she can understand
Allow the child to touch the equipment prior to applying it
Remember to instruct parent as well
12.5 Ambulatory Monitoring for Children
23
12.6 Before the Procedure: Gather Equipment
Monitor with holder and strap or belt
Batteries and tape or disk
Electrodes (3 or 5)
Lead wires
Alcohol and gauze
Patient diary
24
12.6 Before the Procedure: Gather Equipment (Cont’d)
Skin preparation materials
Shaving equipment
Tape
Patient education checklist
Manufacturer’s directions for monitor
Pen
25
12.6 Before the Procedure Prepare monitor and
review instructions Check monitor charge Insert blank tape or disk if
required
26
Clothing should be removed from waist up
Provide drape
Have patient sit or lie down and relax
Dry shave electrode sites, if necessary (clip hair for
telemetry monitoring)
12.6 Prepare the Patient
27
Use alcohol swab and let dry Abrade skin Follow manufacturer’s
instructions for electrode placement
12.6 Place the Electrodes
28
Apply less pressure when abrading skin
Avoid abrasive cleansers
Use caution when applying and removing electrodes
12.6 Elderly or Patients on Certain Medications
29
Attach lead wires to electrodes
Arrange lead wires comfortably on patient
Tape each electrode in place
Attach cable to electrocardiograph and run baseline
ECG
12.6 Applying the Monitor
30
Have patient dress, then attach cable to monitor
Check lead wires and electrodes
Start monitor, have patient make first diary entry
Review all patient instructions
12.6 Applying the Monitor (Cont’d)
31
When applying an unfamiliar type of monitor,
follow manufacturer’s directions
If directions are unavailable, consult supervisor
12.6 Applying the Monitor (Cont’d)
32
Review patient’s diary Turn off monitor and detach lead wires Detach lead wires and cable from patient Remove tape and electrodes Clean skin Record removal procedure on patient’s chart
12.7 Removing the Ambulatory Monitor
33
Follow manufacturer’s instructions for preparing
recording for evaluation
Final interpretation may be done by a physician, usually
a cardiologist within your facility, or sent to an outside
laboratory
12.7 Reporting Results
34
Ensure cassette or results are properly labeled, including: Patient’s name Medical record number Date Physician’s name
Patient diary must be kept with cassette or results
12.7 Reporting Results (Cont’d)
35
Factors affecting accuracy of tracing results: Improper lead attachment Incomplete patient diary Failure of patient to maintain normal routine
If results are sent to an outside lab, report can take seven to ten days
12.7 Reporting Results (Cont’d)
36
Abnormal results may indicate: Electrical conduction defects in heart’s rate and rhythm
controlling system Rhythm abnormalities Premature atrial or ventricular contractions
12.7 Abnormal Results
37
Additional testing that may be required: Echocardiogram Coronary angiogram CT (computerized tomography) scan MRI (magnetic resonance imaging) PET (position emission tomography) scan
12.7 Abnormal Results (Cont’d)