Overview
This protocol outlines standardized procedures for continuous cardiac rhythm monitoring in both inpatient and outpatient settings.
Equipment Requirements
- Continuous cardiac monitor/telemetry unit
- ECG electrodes
- Skin preparation supplies
- Documentation system
Patient Preparation
Pre-Monitoring Assessment
- Verify order and monitoring duration
- Review patient history and current medications
- Explain procedure to patient
- Obtain informed consent when required
Skin Preparation
- Clean electrode sites with alcohol
- Gently abrade skin if necessary
- Ensure skin is completely dry
Electrode Placement
Standard 5-Lead Configuration
- RA (White) - Right arm/infraclavicular
- LA (Black) - Left arm/infraclavicular
- RL (Green) - Right lower rib cage
- LL (Red) - Left lower rib cage
- V1 (Brown) - 4th intercostal space, right sternal border
Monitoring Parameters
Essential Settings
- Heart rate limits: 50-120 bpm (adjust per patient)
- QRS detection threshold: 0.5 mV
- Filter settings: 0.5-40 Hz
Documentation Requirements
- Hourly rhythm strip review
- Daily lead placement check
- Battery status verification
- Alarm parameter adjustments
Response to Alerts
Critical Rhythms Requiring Immediate Response
- Ventricular tachycardia
- Ventricular fibrillation
- Asystole
- Complete heart block
Quality Assurance
- Daily electrode site inspection
- Signal quality assessment q4h
- Weekly equipment maintenance check
Special Considerations
- Pediatric modifications
- Surgical interference precautions
- MRI compatibility protocols