Procedure 101 Setting Up For Continuous Cardiac Monitoring

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1 Chapter 14 Cardiac Care Skills Procedure 100 Performing A 12-Lead ECG Procedure 101 Setting Up For Continuous Cardiac Monitoring Procedure 102 Monitoring The Dorsalis Pedis Pulse Procedure 103 Monitoring The Posterior Tibial Pulse Procedure 104 Postcardiac Catheterization Monitoring

2 Procedure 100 Performing A 12-Lead ECG PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: ECG unit Recording paper Electrodes Alcohol sponges 4 x 4 gauze pads Razor Plastic bag for used supplies Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. If necessary, shave excess hair. Shaving is usually not necessary, but excess hair will interfere with electrode adherence to the skin. Remove skin oil with the alcohol sponges. Allow to dry. Rub the area of electrode placement briskly with the 4 x 4 sponge to abrade the area slightly. The area will appear slightly red. This removes dead skin cells, promoting better contact. 3. Position the limb electrodes. Connect the lead wires. For easy visual identification, each is color-coded and lettered.

3 Procedure Guidelines S/U Initials S/U Initials Right arm lead wire is white, and labeled RA Right leg lead wire is green, and labeled RL Left leg lead wire is red, and labeled LL Left arm lead wire is black, and labeled LA 4. Apply electrodes to the chest. Avoid positioning the electrodes directly on bone, which will cause interference. In the female, position the electrodes below the breast tissue. If the breasts are large, you may have to position the breast laterally. a. Palpate the clavicle (collarbone), which is considered the first rib. Continue palpating downward to the fourth rib. Move down slightly to the space between the fourth and fifth ribs. Position lead V1 in the fourth intercostal space, to the right of the sternum. b. Position lead V2 directly opposite V1 at the left sternal border. c. Next, position lead V4 in the fifth intercostal space at the midclavicular line. d. Position lead V3 halfway between V2 and V4. e. Position leads V5 and V6 laterally to V4. Position V5 in the anterior axillary line. V6 is positioned in the midaxillary line. 5. After applying the electrodes, enter information required by the facility into the ECG cart. Applying electrodes first allows the electrode gel to contact and penetrate the skin surface. 6. Attach the correct lead wire to each electrode. The lead wires are brown.

4 Procedure Guidelines S/U Initials S/U Initials 7. Check the speed on the ECG machine. It should be set to the standard reading of 25 mm/second, unless you are instructed otherwise. Make sure the unit is set to the full voltage. The unit will mark a standardization mark on the paper. Next, enter facility-required patient identification information. When performing the ECG, if part of a wave extends beyond the paper, reduce the normal standardization to half standardization. Note this adjustment on the ECG strip. 8. Ask the patient to lie still and breathe normally. 9. Press the AUTO or RECORD button. Check the tracing quality. If artifact is present, try to correct the problem. It may be necessary to use fresh electrodes. The machine will record the ECG. 10. When the unit finishes recording, remove the lead wires and electrodes. Clean the conductive gel from the patient s skin. 11. Perform your procedure completion Instructor Signature Student Signature

5 Procedure 101 PERFORMANCE REVIEW CHECKLIST Setting Up For Continuous Cardiac Monitoring Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Cardiac monitor Electrodes Lead wires Alcohol sponges 4 x 4 gauze pad Razor (optional) Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. If necessary, shave excess hair. Shaving is usually not necessary, but excess hair will interfere with electrode adherence to the skin. Remove skin oil with the alcohol sponges. Allow to dry. Rub the area of electrode placement briskly with the 4 x 4 sponge to abrade the area slightly. The area will appear slightly red. This removes dead skin cells, promoting better contact. 3. Position the electrodes. Connect the lead wires. 4. Turn the monitor on, if not done previously.

6 Procedure Guidelines S/U Initials S/U Initials 5. Check the monitor for quality of the tracing, and adjust if necessary. 6. Set the heart rate alarm according to facility policy, or as instructed by the RN. Turn the alarm on, if not done previously. 7. Perform your procedure completion Instructor Signature Student Signature

7 Procedure 102 Monitoring The Dorsalis Pedis Pulse PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Watch with second hand Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Imagine a line between the ankle and the fleshy area between the great toe and second toe. Place two or three fingers on this line, over the instep area. 3. Gently palpate the area to determine the pulse location. Mark the area with an X, if so instructed. 4. Count the pulse for 60 full seconds. 5. Perform your procedure completion actions Instructor Signature Student Signature

8 Procedure 103 Monitoring The Posterior Tibial Pulse PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Watch with second hand Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Place your fingers in the groove between the Achilles tendon and the tibia, slightly above the medial malleolus. Move the fingers in, toward the tibia. You may have to press deeply. 3. Gently palpate the area to determine the pulse location. Mark the area with an X, if so instructed. 4. Count the pulse for 60 full seconds. 5. Perform your procedure completion Instructor Signature Student Signature

9 Procedure 104 Postcardiac Catheterization Monitoring PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves (for checking femoral pulse) Stethoscope Blood pressure cuff Watch with second hand Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Check the patient s blood pressure and apical pulse every 15 minutes, or more often as directed. The RN may increase the interval to 30 or 60 minutes after the patient has stabilized. 3. Check the peripheral pulses in the affected extremity: Radial pulse in the upper extremity Dorsalis pedis and posterior tibial pulses in the lower extremity

10 4. Evaluate the affected extremity for: Color Procedure Guidelines S/U Initials S/U Initials Skin temperature Complaints of pain Complaints of numbness or tingling 5. Monitor the site of the skin puncture for edema, bleeding, and signs of hematoma development. Question the patient about pain in the extremity. 6. Ask the patient if he or she is having chest pain. If present, remain in the room and use the call signal to alert the RN. 7. Question the patient about groin, thigh, or back pain. 8. Monitor for signs and symptoms of other complications. 9. Perform your procedure completion Instructor Signature Student Signature

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