Applying a Cardiac Monitor

Goal: A clear waveform, free from artifact, is displayed on the cardiac monitor.

1. Verify the order for cardiac monitoring on the patient’s medical record.

2. Gather all equipment and bring to bedside.

3. Perform hand hygiene and put on PPE, if indicated.

4. Identify the patient.

5. Close curtains around bed and close the door to the room, if possible. Explain the procedure to the patient. Tell the patient that the monitoring records the heart’s electrical activity. Emphasize that no electrical current will enter his or her body. Ask the patient about allergies to adhesive, as appropriate.

6. For hardwire monitoring, plug the cardiac monitor into an electrical outlet and turn it on to warm up the unit while preparing the equipment and the patient. For telemetry monitoring, insert a new battery into the transmitter. Match the poles on the battery with the polar markings on the transmitter case. Press the button at the top of the unit, test the battery’s charge, and test the unit to ensure that the battery is operational.

7. Insert the cable into the appropriate socket in the monitor.

8. Connect the lead wires to the cable. In some systems, the lead wires are permanently secured to the cable. For telemetry, if the lead wires are not permanently affixed to the telemetry unit, attach them securely. If they must be attached individually, connect each one to the correct outlet.

9. Connect an electrode to each of the lead wires, carefully checking that each lead wire is in its correct outlet.

10. If the bed is adjustable, raise it to a comfortable working height, usually elbow height of the caregiver (VISN 8 Patient Safety Center, 2009).

11. Expose the patient’s chest and determine electrode positions, based on which system and leads are being used. If necessary, clip the hair from an area about 10 cm in diameter around each electrode site. Clean the area with soap and water and dry it completely to remove skin secretions that may interfere with electrode function.

12. Remove the backing from the pregelled electrode. Check the gel for moistness. If the gel is dry, discard it and replace it with a fresh electrode. Apply the electrode to the site and press firmly to ensure a tight seal. Repeat with the remaining electrodes to complete the three-lead or fivelead system.

13. When all the electrodes are in place, connect the appropriate lead wire to each electrode. Check waveform for clarity, position, and size. To verify that the monitor is detecting each beat, compare the digital heart rate display with an auscultated count of the patient’s heart rate. If necessary, use the gain control to adjust the size of the rhythm tracing, and use the position control to adjust the waveform position on the monitor.

14. Set the upper and lower limits of the heart rate alarm, based on the patient’s condition or unit policy.

15. For telemetry, place the transmitter in the pouch in the hospital gown. If not available in gown, use a portable pouch. Tie the pouch strings around the patient’s neck and waist, making sure that the pouch fits snugly without causing discomfort. If no pouch is available, place the transmitter in the patient’s bathrobe pocket.

16. To obtain a rhythm strip, press the RECORD key either at the bedside for monitoring or at the central station for telemetry. Label the strip with the patient’s name and room number, date, time, and rhythm identification. Analyze the strip, as appropriate. Place the rhythm strip in the appropriate location in the patient’s chart.

17. Return the patient to a comfortable position. Lower bed height and adjust the head of bed to a comfortable position.

18. Remove additional PPE, if used. Perform hand hygiene.