Monitoring of the patient nursing
Monitoring of the patient procedureSubject: Clinical Skills in Adult Nursing
Assessment of the patient
Edited by: Jacqueline Randle, Frank Coffey, Martyn Bradbury
Background
Electronic monitoring is used most commonly in Emergency Departments and Critical Care Areas. The cardiac monitor is a device that displays the electrical and pressure waveforms of the cardiovascular system for measurement and treatment. Electrical connections are made between the monitor and the patient. Parameters of respiratory function, e.g. oxygen saturation and the respiratory rate can also be monitored. There are numerous different brands of electronic monitor. It is important to have had training on the one in use in the area where you are working. The machines must be calibrated regularly.
Equipment
• Monitor.
• Monitor leads.
• Electrodes.
• Blood pressure cuff.
• Oxygen saturation probe.
Procedure
• Establishing monitoring
• Explain the procedure and gain consent.
• Decontaminate your hands.
• Set up the monitoring equipment, ensuring the patient's safety and dignity are maintained.
• Clean and dry the sites at which the electrodes will be applied (Fig. 3.2).
• If the application site is hairy, clip or shave the hair.
• Check the expiry date of the electrodes.
• Attach the leads to the electrodes.
• Remove the backings from the electrodes before applying them to the patient.
• Place each electrode in its recommended site, applying firm pressure.
• Attach the blood pressure cuff
• Place the oxygen saturation probe on a digit
• Set the alarm limits, as appropriate for the patient.
• Record baseline observations.
Ongoing monitoring
• Check regularly that the electrodes and other attachments remain in place.
• Ensure that the patient's skin is protected from pressure injury from repeated blood pressure measurements.
• Record readings at a frequency appropriate to the severity and stability of the patient's condition.
• Record the time and nature of any interventions or treatments that might impact on readings.
Practice tips
• Keep the patient warm and relaxed—this will help to minimize muscle and movement artefact.
• Ensure the electrodes are firmly attached—this ↓ artefact and prevents the conductive gel from drying out.
• Place the electrodes over bone rather than muscle to minimize interference from muscle artefact in the electrocardiogram (KG) signal.
• If the patient is sweaty or clammy, it might be necessary to dry the area and change the electrodes.
• Don't apply electrodes over injured areas, scar tissue, burns, rashes, or other lesions—different positions might be used, as necessary.
• Most leads are colour coded to aid correct connection. The usual scheme (except in the United States) is red for right arm lead, yellow for the left arm and green for the leg lead (usually placed on the abdomen or lower left chest wall).
• Medical equipment might provoke anxiety in the patient and relatives— explain its purpose and reassure them.
• Ensure that the monitor is plugged into the mains if possible—this will ensure that the battery is fully charged if transfer is required.
• If the monitor is dropped or damaged, always have it serviced, even if it seems to be functioning correctly.
Pitfalls
• Using electrodes that are out of date or for which the conductive gel has liquefied or dried out.
• Applying electrodes in fatty areas or over major muscles, large breasts, or bony prominences.
• Treating the monitor rather than the patient. It has been known for the cardiac arrest team to be called to a patient with Ventricular fibrillation' on the monitor when in fact it was an artefact caused by the patient cleaning their teeth.
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