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Tr ou bleshoo t i n g ca r diac m o nit o r

p r o blems
For optimal cardiac monitoring, you need to recognize problems
that can interfere with getting a reliable ECG recording. Causes of
interference include artifact from patient movement and poorly
placed or poorly functioning equipment.

An artifact, also called waveform interference, may be seen with

excessive movement (somatic tremor). It makes the baseline of
the ECG appear wavy, bumpy, or tremulous. Dry electrodes may
also cause this problem because of poor contact.

Electrical interference, also called AC interference or 60-cycle

interference, is caused by electrical power leakage. It may also
result from interference from other room equipment or improperly
grounded equipment. As a result, the lost current pulses at a rate
of 60 cycles/second. This interference appears on the ECG as a
baseline that’s thick and unreadable.

For a look at the most commonly encountered monitor problems,

including the way to identify them, their possible causes, and in-
terventions, see the next page.

Source: Interpreting Difficult ECGs: A Ready Reference, Lippincott Williams & Don’ t f o r g e t t o assess t h e
Wilkins, 2006. pa t i e n t f irs t!
Take5 © 2007 Lippincott Williams & Wilkins. Available online at http://
www.nursing2007.com (click the “Educators” button).
Waveform Possible Interventions Waveform Possible Interventions
causes causes
Artifact (waveform ■ Patient experi- ■ If the patient is having a sei- Weak signal ■ Improper elec- ■ Reapply the electrodes.
interference) ences seizures, zure, provide emergency care trode application
chills, or anxiety and notify the physician.
■ Keep the patient warm and ■ QRS complex ■ Reset gain so the height of the com-
encourage him to relax. too small to reg- plex is greater than 1 mV.
ister ■ Try monitoring the patient on another
■ Dirty or corroded ■ Replace dirty or corroded lead.
connections wires.
■ Wire or cable ■ Replace any faulty wires or cables.
■ Improper elec- ■ Check the electrodes and failure
trode application reapply them if needed. Clean
the patient’s skin well, because Wandering baseline ■ Patient rest- ■ Encourage him to relax.
skin oils and dead skin cells lessness
inhibit conduction. ■ Exaggerated ■ Make sure that tension on the cable
■ Dry electrode gel ■ Check the electrode gel. If it’s chest wall move- isn’t pulling the electrode away from
dry, apply new electrodes. ment during the patient’s body.
respiration
■ Short circuit in ■ Replace broken equipment
lead wires or cable ■ Improper elec- ■ Reposition improperly placed elec-
trode application; trodes.
electrode posi-
■ Electrical interfer- ■ Make sure all electrical equip- tioned over bone
ence from other ment is attached to a common
equipment in the ground. Fuzzy baseline ■ Electrical inter- ■ Make sure that all electrical equip-
room ■ Check all three-pronged plugs (electrical interfer- ference from ment being used, such as an I.V.
to make sure no prong is loose. ence) other equipment pump, is attached to a common
Notify biomedical department. in the room ground.
■ Check all three-pronged plugs to
■ Static electricity ■ Regulate room humidity to make sure no prong is loose. Notify
interference from 40% if possible. biomedical department.
inadequate room
humidity

False high-rate alarm ■ Gain setting too ■ Assess the patient for signs
■ Improper elec- ■ Reposition improperly placed elec-
high, particularly and symptoms of hyperkalemia. Baseline (no wave-
with MCL1 setting Reset gain. form) trode placement trodes.

■ HIGH alarm set ■ Set alarm limits according to ■ Electrode dis- ■ Check for disconnected electrodes.
too low or LOW the patient’s heart rate. connection
alarm set too high.
■ Dry electrode ■ Check electrode gel. If it’s dry, apply
gel new electrodes.
■ Wire or cable ■ Replace any faulty wires or cables.
failure