With every ECG alarm, the patient should be visualised and assessed (refer to Nursing Assessment Clinical Guideline). A patient on telemetry should be visualised hourly.Nurses looking after patients on telemetry must have completed the following Nursing Competencies: Monitoring (Basic) and Monitoring – Advanced EC.Additional ECG’s should be performed if ECG changes from patient baseline Prior to commencing telemetry monitoring a baseline 12 or 15 lead ECG should be taken as per cardiac team.Frequent unexplained episodes of sudden collapse.Patients/Families unable/unwilling to follow nursing instructions to stay on the ward.Unwell patients at risk of life threatening arrhythmia (VF, SVT, VT, atrial flutter).Patients with any life threatening arrhythmia in the previous 24 hours.Post-operative patients still under post-operative observations. Exclusion criteria for telemetry, in consultation with cardiac team Monitor until cause has been identified, treated and/or the patient is at nil further riskįor every patient on telemetry – There should be both a daily medical and nursing assessment on the need for continuous cardiac monitoring and this should be documented daily. Unexplained sudden collapse or other neurological signs/symptoms that might be due to cardiac arrhythmias Pharmacotherapy of pro-arrhythmic drugs causing actual or potential QT prolongation or ventricular dysrhythmias e.g commencement of risperidone Monitor until reversible cause is rectified Sinus bradycardia without haemodynamic compromise Stable patients diagnosed with (and not limited to) cardiomyopathy, pericarditis, endocarditis, pericardial effusion or other conditions that may cause arrhythmiaĬontinue to monitor throughout treatment, until the risk of arrhythmia has been cleared. Post electrophysiology study and catheter ablation Non-life threatening arrhythmia without haemodynamic compromise Indications for telemetry include, in consultation with cardiology team, but not limited to Indication for Telemetry The algorithm is not strong enough to support infants and neonates (as directed by Philips). The size of the electrodes are generally too big for patients this age, and this can cause incorrect readings and problems with skin integrity. Patients aged 2 years and less are not recommended for telemetry. The AUM will be involved in all aspects of care, from patient assessment and daily reviews for appropriateness of telemetry. Acutely unwell patients at risk of life-threatening arrhythmias should be on strict bed rest and continuously monitored on the bedside monitor and close to emergency equipment. Patients should be assessed daily for the appropriateness of cardiac telemetry. Collapse – For the purpose of this guideline – collapse refers to circulatory/hemodynamic collapse.This can occur through transcutaneous pacing or external wires coming from the atrium/ventricle External Pacing – Temporary means of pacing a patient’s heart.Arrhythmia – A rhythm in which the heart beats in an irregular or abnormal rhythm.Lead Wire- The lead that connects the electrodes to the telemetry unit.Electrode – The patch that is placed onto the patient and attaches to the lead wire.ECG – Electrocardiogram is a diagnostic tool that measures and records the electrical activity of the heart via electrodes placed on the skin.Telemetry – A portable device that continuously monitors patient ECG, respiratory rate and/or oxygen saturations while automatically transmitting information to a central monitor.To guide Safe and competent nursing and medical practice associated with the use of cardiac telemetry monitoring. Nurses who are able to identify ECG abnormalities are in prime position to prompt immediate action and lessen patient complications. Studies have shown that with appropriate education to the patient and family, patient safety is improved and anxiety associated with monitoring is reduced. Telemetry accuracy relies on skin preparation, electrode and lead placement, equipment maintenance, patient monitoring and education. Telemetry is not a replacement for patient visualisation and assessment. The patient group requiring telemetry are children diagnosed with a known/unknown arrhythmia, children at risk of an arrhythmia, or children anticipated to be at risk of sudden cardiac deterioration. Telemetry is an observation tool that allows continuous ECG, RR, SpO 2 monitoring while the patient remains active without the restriction of being attached to a bedside cardiac monitor. Note: This guideline is currently under review.
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