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.

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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?

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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)

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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)

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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?

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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

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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

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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

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12.3 Transtelephonic Monitoring

Primarily used to evaluate pacemaker function Can be used for monitoring patients longer than 24 to

48 hrs

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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

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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

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Post-Symptom Event Monitor (Cont’d)

Wristwatch type is worn at all times Used to document dysrhythmias that last more than

a few seconds

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12.3 Loop-memory Monitor May remain on chest for 30 days or more Memory on monitor can hold up to five minutes

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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

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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:

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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

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All usual and unusual activities, such as: Urinating, bowel movements Sexual activity Walking Emotional upset Eating Sleeping

12.4 Diary – What Is Recorded

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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

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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

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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)

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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

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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

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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

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12.6 Before the Procedure: Gather Equipment (Cont’d)

Skin preparation materials

Shaving equipment

Tape

Patient education checklist

Manufacturer’s directions for monitor

Pen

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12.6 Before the Procedure Prepare monitor and

review instructions Check monitor charge Insert blank tape or disk if

required

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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

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Use alcohol swab and let dry Abrade skin Follow manufacturer’s

instructions for electrode placement

12.6 Place the Electrodes

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Apply less pressure when abrading skin

Avoid abrasive cleansers

Use caution when applying and removing electrodes

12.6 Elderly or Patients on Certain Medications

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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

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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)

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When applying an unfamiliar type of monitor,

follow manufacturer’s directions

If directions are unavailable, consult supervisor

12.6 Applying the Monitor (Cont’d)

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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

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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

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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)

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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)

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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

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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)