Cardiac Telemetry & 6 Critical Indications

Cardiac telemetry is a method of remotely monitoring a person’s vital signs. A cardiac telemetry unit often consists of many patient rooms with vital sign monitors that send data such as your heart rate, respiration, and blood pressure to a nearby site regularly.

A professionally trained nurse keeps track of your vital signs and can react to any changes that could indicate a concern with your health.

A telemetry is a monitoring tool that enables continuous ECG, RR, and SpO2 monitoring when the patient is active and not tethered to a bedside cardiac monitor.

Children with a known or unknown arrhythmia, children at danger of arrhythmia, or children at risk of abrupt cardiac deterioration are among the patients who require telemetry. Telemetry is not a substitute for visualizing and assessing patients.

Skin preparation, electrode, and lead placement, equipment maintenance, patient monitoring, and education all contribute to telemetry accuracy. Patient safety is increased and anxiety-related monitoring is minimized, according to studies, when the patient and family are properly educated. Nurses who can recognize ECG irregularities are in a great position to take fast action and reduce patient suffering.

Cardiac telemetry may be recommended by your doctor for a variety of reasons:

  • Abnormal Heartbeatsal (arrhythmias such as atrial fibrillation)
  • With an unsteady heart rhythm, you may have chest pain.
  • Cardioversion, which corrects aberrant heart rhythms, is monitored in conjunction with other heart operations.
  • Before or after open-heart surgery, you should be monitored.
Cardiac Telemetry
Fig 1: ECG rhythm

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The Cardiac Telemetry Unit: What to Expect?

If you’re admitted to a cardiac telemetry unit, one of our skilled nurses will place different vital sign sensors on your body, including:

  • Wear a blood pressure cuff on your arm to continuously monitor your blood pressure.
  • On your finger, wear an oxygen monitor (pulse oximeter) to measure the amount of oxygen in your blood.
  • Monitor your heart rate and rhythm via EKG (electrocardiogram, or ECG) leads on your chest.
  • The blood pressure cuff will inflate at regular intervals, and the other leads will transfer data to a monitor in your room and the telemetry nurse’s room in a discreet manner.

A cardiac telemetry unit is similar to any other department in a hospital. Intravenous (IV) assistance is likely, and you’ll get the same degree of nurse care as patients in other departments.

A cardiac telemetry unit has a lot of patients who are recovering from heart disease or treatment. If the rhythm is stabilized then one can get the discharged from hospital  

Fig2: 3 point electrode system

Assessing cardiac telemetry

The use of cardiac telemetry in patients should be evaluated daily. Acutely ill patients who are in danger of developing life-threatening arrhythmias should be kept in bed and constantly monitored with a bedside monitor and kept close to emergency equipment. The AUM will be involved in all aspects of care, including patient assessment and daily telemetry reviews.

Telemetry is not suggested for children under the age of two. The electrodes are typically excessively large for patients this age, which might result in inaccurate readings and skin integrity issues. The algorithm is insufficient to support babies and newborns.

In conjunction with the cardiology team, cardiac monitoring indications for telemetry include, but are not limited to:

Telemetry Indication Cessation Criteria /Duration
Arrhythmia that isn’t life-threatening with no hemodynamic compromiseContinue to monitor until the arrhythmia is under control.
Catheter ablation and post electrophysiological studyA specific cardiac team should monitor
Patients are stable and diagnosed but not limited to cardiomyopathy, pericarditis, endocarditis, or other condition causing arrhythmiaMonitoring through the treatment until the risk of arrhythmia has cleared.
No hemodynamic compromise but have sinus bradycardiaThe patient needs to be under supervision until the reversible cause is identified.
Administration of pro-arrhythmic drugs causes actual or potential QT prolongation or ventricular dysrhythmias.Duration is based on risk stratification
Sudden collapse or sometimes other neurological symptoms may be due to cardiac arrhythmiasThe patient should be monitored Until the cause is identified and the risk is nil
Table 1 Indication of cardiac arrythmia

Placement of Cardiac telemetry

  • Preparing the skin
  • The skin should be washed with soap and water.
  • Rinse well to eliminate all soap residue.
  • If your skin is oily or you’ve had diaphoresis, wipe it down with an alcohol swab (if skin integrity is compromised do not use alcohol)
  • To enhance capillary blood flow and eliminate skin cells and oil, rub the skin with gauze.
cardiac telemetry
Fig 3: 6 point electrodes

Placement of electrode

To avoid skin breakdown and allow for optimal conduction, electrodes should be replaced regularly. To eliminate muscular artifacts during limb movement, limb electrodes are implanted on the torso.

Kendall 130 foam electrodes from Covidien must be used. Philips does not approve or support the Covidien Kendall 1050NPSM newborn electrodes for telemetry.

Telemetry has 5 electrodes by the help of which it works.

  • White – The right arm (RA) is positioned close to the right shoulder in the infraclavicular fossa.
  • Black – The left arm (LA) is positioned close to the left shoulder in the infraclavicular fossa.
  • Red-The left leg (LL) is located on the left upper quadrant of the abdomen, below the rib cage.
  • Green – The right leg (RL) is placed on the right upper quadrant of the abdomen, below the rib cage.
  • Brown- (V1) is positioned below the rib cage, between the xiphoid process and (RL).

If the patient has a permanent pacemaker, the following steps should be taken:

  • If the pacing spikes are not being picked up by the monitor, shift the RA electrode down to the 5th intercostal space and the LL electrode up to the 5th intercostal space.
  • Misplaced leads can cause misdiagnosis; for example, if the RA is shifted by one intercostal space, VT could be mistaken as SVT or vice versa.
  • If a patient has dextrocardia, the leads must be switched to the opposite side of the body, or the ECG will show inverted P and T waves.

What is the best way to install telemetry?

Cardiac telemetry is implanted in the patient’s heart. Ascertain that the patient is placed on central and bedside monitoring. In the telemetry gadget, put the battery in. Telemetry should be added to central monitoring as a piece of equipment, and it should be shown on the bedside monitor. The name of the patient will appear at the top of the telemetry screen.

What’s the difference between telemetry and cardiac monitoring?

Telemetry can be utilized for listening, recording, and delivering atrial fibrillation burden estimates, while monitors are mostly employed for continually recording data.

What’s the difference between a Holter monitor and a telemetry monitor?

Both Holter monitors and telemetry devices require the patient to wear leads. Holter monitors, on the other hand, often require more leads and are bulkier. A telemetry device is smaller, sleeker, and easier to wear as a result of the technology it employs.

What is cardiac telemetry’s significance?

Areas can be regulated and controlled remotely using telemetry. Temperature, pressure, humidity, movement, and illumination, among other sensors, may all be controlled and monitored with it. Telemetry allows measurements to be taken without having to be present, regardless of distance or movement.

What is the difference between an electrocardiogram (ECG) and telemetry?

While both EKGs and Cardiac telemetry monitor a patient’s unique electrocardiogram for a long enough duration to gather data, they are not the same. EKG technicians do a more specific type of monitoring than telemetry, which is a more generic form of monitoring.

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