• Cardiac monitoring and electrode placement revisited

    by Alan Batt. Last modified: 08/05/14



    Hannibal GB. Cardiac monitoring and electrode placement revisited. AACN Adv Crit Care. 2014 Apr-Jun;25(2):188-92. PMID: 24752032.


    One purpose of the PULSE study was to evaluate nurses’ knowledge of accurate cardiac monitoring practices on the basis of the 2004 standards for cardiac monitoring in hospitalized patients. Those standards made specific recommendations for both optimal populations that benefit from cardiac monitoring and the 4 domains of continuous cardiac monitoring: rate, rhythm, ST-segment monitoring, and QT monitoring. The baseline data of the PULSE trial contain revealing statistics on the manner in which cardiac monitoring is actually used in hospitals. The researchers studied 1816 patients in 17 hospitals and reviewed medical records, observed actual practice (electrode placement and leads displayed), and compared monitoring equipment stored memory with nursing documentation.

    Findings showed that limb electrodes were misplaced 15% to 27% of the time, and chest electrodes were misplaced up to 76% of the time (based on variance from the standard precordial electrode positions). The researchers also found that nurses documented heart rhythm change only 51% of the time, appropriately monitored for ischemia only 41% of the time, and documented the QTc (an important warning sign for repolarization abnormalities) when indicated only 20% of the time. Although the ultimate aim of the trial was to ascertain whether an electronic education program could change and align practice with the recommendations of the 2004 standards, the baseline data itself suggest a call to action.


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    Alan Batt

    Alan Batt

    Paramedic, educator, researcher
    Alan is a critical care paramedic, paramedic educator and prehospital researcher, currently working around the world as an educator and researcher. He has previously worked and studied across Europe, North America and the Middle East. He holds a Graduate Certificate in Intensive Care Paramedic Studies, and an MSc in Critical Care. His main interests are in care of the elderly, end-of-life care, patient safety, professionalism (including role and identity), and paramedic education.

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