Electrocardiogram (ECG/EKG) Monitoring
Category: Cardiovascular
Overview
Continuous cardiac monitoring to assess heart rhythm, rate, and electrical activity for early detection of arrhythmias and cardiac events.
Indications
Chest pain, arrhythmias, cardiac medication administration, post-cardiac procedures, hemodynamic instability, electrolyte imbalances, critically ill patients.
Contraindications
Severe burns or open wounds at electrode sites, patient refusal, allergy to electrode adhesive.
Equipment Needed
Cardiac monitor, lead wires, disposable electrodes, alcohol swabs, razor (if needed), towel.
Procedure Steps
1. Explain procedure to patient and obtain consent
2. Ensure patient privacy and position comfortably
3. Identify proper electrode placement sites
4. Clean skin with alcohol and allow to dry
5. Shave hair if necessary for good electrode contact
6. Apply electrodes to clean, dry skin with firm pressure
7. Attach lead wires to electrodes according to system
8. Turn on monitor and check for clear waveform
9. Set appropriate alarm limits based on patient condition
10. Document initial rhythm strip and settings
11. Ensure leads are secured to prevent artifact
12. Educate patient about movement restrictions
Safety Considerations
Ensure proper electrode placement to avoid artifact. Check skin integrity under electrodes regularly. Replace electrodes every 24-48 hours or per policy. Keep backup electrodes available. Ensure alarm limits are appropriate for patient.
Potential Complications
Skin irritation or breakdown, electrode displacement, false alarms, failure to detect arrhythmias, electrical interference.
Documentation
Record initial rhythm, rate, electrode placement, alarm settings, patient tolerance, and any rhythm changes or interventions.
References
American Heart Association. (2020). 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. American Association of Critical-Care Nurses Practice Alert.