I stare into the embossed letters above the door. ICU-CCU Complex.

So this is where critical patients are attended to. As part of my

training as a newly registered nurse, I get to be assigned to
different departments of the hospital, this week, its the ICU.
Back when I was a student up until now, I always look up to ICU
nurses. The way they go in and out of those mysterious glass doors,
wearing colorful scrub suits other than the typical white uniform.
They dont wear caps, instead they go around during codes giving
out an aura that they wear invisible capes. This is the moment I get
to finally experience being one.
Okay, welcome to the ICU unit, where the patient to staff ratio is
1:1. Here, you will encounter more cases and learn more complex
procedures, the head nurse says as she orients us with other
policies and protocols in the area. I look around and note that
patients are separated in cubicles, with Christmas-tree like IV lines
and tubes attached to their mouth. I hear a strange beeping sound
and glance around trying to seek where it comes from. In that
moment, I realize that is coming from a monitor located at the
bedside with lines, tracings and the patients vital signs. I have
heard of it before. However, seeing it actually for the first time
makes me want to review some concepts I learned back in nursing
school. Yes, this is the cardiac monitor, and it is attached to the
patient. But what does it actually do? Why the need to attach the
patient to it when vital signs can be taken manually?

Cardiac monitoring: An overview

ardiac monitoring is the act of ct of keeping a patient

connected to a cardiac electrocardiogram (EKG) or a similar device

to keep track of and record the hearts activity, showing if the heart
is functioning well or of certain abnormalities and malfunction are
present.
Usually, this is ordered for patients requiring intensive care and
those in the emergency department, but it may also be ordered in
patients with cases that may need cardiac monitoring. It may be
ordered for patients with a serious condition and needs intense
monitoring, stable patients with certain heart problems, and those in
surgery or have other conditions that may affect heart rhythm.
In some cases, it may involve having to print out the hearts
impulses as well as beats. In other cases, it involves a device which
may keep track of output, input and blood oxygen levels. Usually,
cardiac monitors use devices that are attached to the patient in the
forms of electrodes and probes. In order to monitor the patients
blood pressure, a BP cuff attached to the cardiac monitor may be
used.

Electrodes
An ECG trace may be positioned in different ways, however, they are
most typically arranged in a standard position each time in order to
detect abnormalities easier. Electrodes are most commonly attached
to the chest and limbs of the patient.
Other monitors have 3 leads. The Red electrode is attached to the
right arm, (or second intercostal space on the right of the sternum);

the Yellow electrode is attached to the left arm (or second intercostal
space on the left of the sternum) and the Green/Black electrode is
placed at the left leg (or more often in the region of the apex beat.)
Here, the monitor displays the bipolar leads (I, II and III).
For the 5-electrode system, 5 electrodes are used. The White
electrode is attached to the Right arm (2 intercostals space), the
nd

Black electrode to the Left arm (2 intercostals space), the Brown

nd

electrode to the chest, the Green electrode to the Right leg and the
Red electrode to the Left leg. Still, this displays the bipolar leads (I, II
and III) and asingle unipolar lead, depending on the position of the
brown chest lead (positions V1-V6).
In 12-lead ECG, 12 electrodes are used to produce 12-lead ECG.
These electrodes are places on all fours limbs (RA, LL, LA, RL) and on
precordium (V1-V6). This monitors 12-leads from V1-V6, I,II,III, and
aVR, aVF, and aVL. It also allows interpretation of specific areas of
the heart. For example Inferior (II, III and aVF), Lateral (I, aVL, V5
and V6), and anterior (V1-V4). Here, a wide range of abnormalities
may be detected.
For patients on anesthesia, ECG may be monitored using the 3 or 5electorde system. However, it provides a more restricted analysis of
the cardiac electrical activity compare to that of the 12-lead ECG.

Nurses Role
Unlike physicians and other health professionals, we nurses stay
with the patient and care for them for longer periods of time. When
caring for a patient in ICU needing cardiac monitoring, the nurse is
expected to assume certain responsibilities regarding the carrying
out of this order.

The nurse is the one who prepares the patient to get attached to
electrodes connected to the monitor. She is responsible for making
sure that the site is hair free and clean. The area may be washed or
hair may be shaved.
After which, she is responsible for placing the electrodes correctly to
the patient. Accurate placement of the electrodes is a much as
improper placement of the electrodes may sure inaccurate results.
The nurse is also expected to observe the monitor, looking out for
certain abnormalities and deviations as well as ensuring the setup is
adjusted correctly. The nurse must be alert for some abnormal
findings that may warrant immediate medical attention and
interventions, especially in emergencies.

In nursing, it is not enough that we only know that some device is

there and ready to use. We must also understand its functions and
how to manipulate it. The nurse must also be knowledgeable when it
comes to the expected andnormal values and some deviations in
order to know when to act and how to properly address a problem
when you sense it.
Sources:

http://www.wisegeek.com/what-is-cardiac-monitoring.htm

http://lifeinthefastlane.com/education/procedures/leadpositioning/

http://www.ebme.co.uk/articles/clinical-engineering/20-cardiacmonitoring

http://www.ehow.com/list_6145396_nursing-responsibilitiespatient-cardiac-monitoring.html

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