Managing an ECG Monitor

Managing an ECG Monitor involves setting up a continuous recording of the electrical activity of the heart, ensuring the recorder is functioning correctly, and interpreting the tracing. An electrocardiography monitor, or cardiac monitor, can be used to observe cardiac rhythm. It displays a single lead trace on a screen, in real time. ECG monitoring should be used in patients who may be at risk of developing arrhythmias, otherwise known as an abnormal rate or rhythm. This is to enable early detection and treatment of these arrhythmias, which may lead to cardiac arrest. The trace from an ECG monitor should only be used for rhythm recognition, not the analysis of other ECG abnormalities such as ST segment changes. When an arrhythmia occurs, a 12-lead ECG should ideally be recorded alongside the single lead monitoring trace. The procedure of Recording a 12 lead ECG is covered elsewhere in the Tomorrow’s Clinicians series.

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Obtaining Written Consent

Patients have a fundamental legal and ethical right to determine what happens to their bodies. Consent must be taken before performing any examination, procedure or treatment on a patient who has capacity. If consent is not taken, the examination or procedure can be viewed as battery and is liable to prosecution. Taking consent negates the charge of battery. Consent can be implied, verbal or written. For most examinations and minor procedures on the ward, implied and verbal consent is sufficient.

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Blood Transfusion

Administering a blood transfusion is the process of giving blood, or components of blood, into the vein of a patient. When undertaking this procedure, it is essential to ensure that the right component is given to the right patient, at the right time, and for the right reason. The procedure can only be performed by a qualified practitioner who has been trained and assessed as being competent in the process. This will be either a registered nurse, a fully qualified operating department practitioner, or a medical practitioner. It is essential to ensure all the relevant checks of the patient and blood component are carried out, to ensure the administration of the correct component to the correct patient. Administration of the wrong component to the wrong patient can result in a fatal transfusion reaction. It is vital to monitor the patient before, during, and after the procedure for possible reactions to the transfusion, and to take appropriate action if necessary. The following procedure is applicable when transfusing red cells, fresh frozen plasma, platelets, cryoprecipitate and granulocytes. The procedure will be demonstrated for a red cell transfusion.

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Measuring Blood Pressure (Auto)

The pulse rate is a peripheral measure of the heart rate. It can be measured using manual techniques or automatic electronic devices. The pulse rate is a simple measurement that clinicians can use to assess patients’ physiological status. Serial measurements are useful in monitoring patients, and identifying changes in a patient’s condition. Examples of electronic devices which measure and display pulse rate include; pulse oximeters and electronic blood pressure monitors. It is important to note that while these devices will show the pulse rate, they will not give any information regarding the rhythm or character of the pulse for this, the pulse measurement should be taken manually.

Once you have watched this video, why not attempt the multiple choice quiz to test your knowledge?

Measuring Pulse Rate (Auto)

The pulse rate is a peripheral measure of the heart rate. It can be measured using manual techniques or automatic electronic devices. The pulse rate is a simple measurement that clinicians can use to assess patients’ physiological status. Serial measurements are useful in monitoring patients, and identifying changes in a patient’s condition. Examples of electronic devices which measure & display pulse rate include; pulse oximeters and electronic blood pressure monitors. It is important to note that while these devices will show the pulse rate, they will not give any information regarding the rhythm or character of the pulse – for this, the pulse measurement should be taken manually.

Once you have watched this video, why not attempt the multiple choice quiz to test your knowledge?

Radial Arterial Blood Gas

An arterial blood gas is performed to measure oxygen and carbon dioxide levels, as well as the acid-base balance in the arterial circulation. The radial artery site is commonly used to obtain a sample, as it is superficial and easily accessible. The accurate determination of blood gas and acid base status is an extremely important procedure in the clinical management of patients, and must be performed correctly to minimise erroneous results. These measurements give us vital information concerning the partial pressure of oxygen being supplied to tissues; the level of alveolar ventilation; the efficiency of gas exchange and the general metabolic state of the body. This can help us to determine the severity of a condition and monitor the progress of treatments, such as the provision of supplemental oxygen.

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Intravenous Cannulation

This episode of the Tomorrow’s Clinicians series looks at the procedure of Intravenous Cannulation.

A cannula is a flexible plastic tube, which is inserted into a vein to allow medication and or fluid to be administered intravenously. When choosing the cannula size, you must take into account the intended use for the cannula and the accessibility of the patient’s veins. Aim to use the smallest appropriate cannula to meet the clinical need in order to minimise vascular complications.

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Recording a 12 Lead ECG

This episode looks at the procedure of Recording a 12 Lead ECG.

An electrocardiogram, or ECG, is performed to assess the rhythm and electrical activity of the heart.

To record an ECG, electrodes must be placed in specific positions on the patient’s limbs and chest wall, then connected via leads to an ECG machine, which records the electrical activity. The ECG machine produces a trace, which must then be analyzed by a qualified member of staff. It is important that the recording of the ECG is done accurately, to ensure that the patient can be treated appropriately.