Continuous ST-Segment Monitoring: Protocol for Practice

Sandau, Kristin E.; Smith, Maureen

doi:10.4037/ccn2009703

Cited by 16 publications

(17 citation statements)

References 46 publications

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“…A thoughtful decision by nurses, physicians, and biomedical engineers at each hospital is critical to identifying an interprofessional protocol for ischemia monitoring, including identifi cation of which hospital units commonly admit the patient populations who may benefit from continu ous ischemia monitoring. 39 Some hospitals have cho sen to have STsegment monitoring as a default for all patients in ICUs and telemetry units; unfortunately, this is likely to result in overuse of STsegment moni toring because busy nurses may neglect to turn off the function when a patient does not meet criteria. To reduce unnecessary monitoring and alarms, the writ ing group recommends setting the STsegment moni toring default to "off" because only a select group of patients will potentially benefit from this moni toring.…”

Section: Methods Used To Measure St-segment Changesmentioning

confidence: 99%

“…The neces sity for correct electrocardiographic electrode place ment also applies to continuous STsegment monitor ing. Continuous STsegment monitoring may differ in measurement method compared with exercise stress testing and core laboratories in that a measurement at 60 milliseconds beyond the J point is commonly re ported for studies or protocols specific to continuous STsegment monitoring, 19,31,39 in an attempt to reduce the potential for false alarms that may occur if the measurement is taken at 80 milliseconds beyond the J point where the upslope of the T wave begins. 40 Fur ther study is needed.…”

Section: Accurate Electrode Placement and Interpretationmentioning

confidence: 99%

“…1,39,447,457,458 Adequate educa tion is crucial for correct interpretation of electrocar diographic waveforms and data and proper care of patients undergoing continuous electrocardiographic monitoring. Incorrect interpretation can result in un necessary diagnostic or surgical interventions.…”

Section: Education Of Staffmentioning

confidence: 99%

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Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Sandau¹,

Funk²,

Auerbach³

et al. 2017

Circulation

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201

214

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Background and Purpose: This scientific statement provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration, and implementation of continuous electro cardiographic monitoring of hospitalized patients. Since the original practice standards were published in 2004, new issues have emerged that need to be addressed: overuse of arrhythmia monitoring among a variety of patient populations, appropriate use of ischemia and QT-interval monitoring among select populations, alarm management, and documentation in electronic health records. Methods: Authors were commissioned by the American Heart Association and included experts from general cardiology, electrophysiology (adult and pediatric), and interventional cardiology, as well as a hospitalist and experts in alarm management. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Authors were assigned topics relevant to their areas of expertise, reviewed the literature with an emphasis on publications since the prior practice standards, and drafted recommendations on indications and duration for electrocardiographic monitoring in accordance with the American Heart Association Level of Evidence grading algorithm that was in place at the time of commissioning. Results: The comprehensive document is grouped into 5 sections: (1) Overview of Arrhythmia, Ischemia, and QTc Monitoring; (2) Recommendations for Indication and Duration of Electrocardiographic Monitoring presented by patient population; (3) Organizational Aspects: Alarm Management, Education of Staff, and Documentation; (4) Implementation of Practice Standards; and (5) Call for Research. Conclusions: Many of the recommendations are based on limited data, so authors conclude with specific questions for further research.

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Section: Methods Used To Measure St-segment Changesmentioning

confidence: 99%

Section: Accurate Electrode Placement and Interpretationmentioning

confidence: 99%

See 1 more Smart Citation

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Sandau¹,

Funk²,

Auerbach³

et al. 2017

Circulation

Self Cite

201

214

View full text Add to dashboard Cite

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“…A helpful table for selecting the best leads for viewing suspicious coronary arteries was provided by Sandau and Smith. 22 …”

Section: Case Study 2: Selection Of Appropriate Leads For Monitoring mentioning

confidence: 99%

Continuous ST-Segment Monitoring: 3 Case Studies in Progressive Care

Sandau

Smith

2009

Critical Care Nurse

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“…Although the 12-lead ECG is the standard for detecting myocardial ischemia, it provides a static snapshot rather than a continuous recording of the dynamic changes that can be seen by using continuous ischemia monitoring. 4 Because ischemia can be silent, episodes can be missed. Therefore, the American Heart Association/American Association of Critical-Care Nurses practice standards for ECG monitoring 5 recommend continuous ischemia monitoring for all patients at marked risk for myocardial ischemia that, if sustained, might result in acute myocardial infarction or extension of a myocardial infarction (Table 1).…”

mentioning

confidence: 99%

Continuous ST-Segment Monitoring: Nurses’ Attitudes, Practices, and Quality of Patient Care

Sangkachand

Sarosario

Funk

2011

American Journal of Critical Care

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Background Continuous ischemia monitoring helps identify patients with acute, but often silent, myocardial ischemia. Evidence suggests nurses do not activate ischemia monitoring because they think it is difficult to use. ST-Map software incorporates graphic displays to make monitoring of ongoing ischemia easier. Objectives To determine if nurses’ use of and attitude toward ischemia monitoring and the quality of patient care improve with use of ST-Map. Methods The study included 61 nurses and 202 patients with acute coronary syndrome in a cardiac intensive care unit. Baseline data on nurses’ use of and attitude toward ischemia monitoring and quality of care were obtained. Education was then provided and ST-Map software was installed on all monitors. Follow-up data were obtained 4 months later. Results The percentage of nurses who had ever used ischemia monitoring was 13% before ST Map and 90% afterward (P < .001). The most common reason for not using ischemia monitoring before ST Map was inadequate knowledge (62%). The most common reason for liking ischemia monitoring after ST Map was knowing when a patient has ischemia (80%). Time to acquisition of a 12-lead electrocardiogram in response to symptoms or ST-segment changes was 5 to 15 minutes before ST Map and always less than 5 minutes afterward (P < .001). Time to return to the catheterization laboratory did not differ before and after ST Map. Conclusions ST Map was associated with more frequent use of ischemia monitoring, improved attitudes of nurses toward ischemia monitoring, and shorter time to obtaining 12-lead electrocardiograms.

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Continuous ST-Segment Monitoring: Protocol for Practice

Cited by 16 publications

References 46 publications

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Continuous ST-Segment Monitoring: 3 Case Studies in Progressive Care

Continuous ST-Segment Monitoring: Nurses’ Attitudes, Practices, and Quality of Patient Care

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