Clinical Guidelines (Nursing) : Cardiac telemetry – Royal Children’s …

Introduction

Telemetry is an observation tool that allows continuous ECG, RR, SpO2 monitoring while the patient remains active without the restriction of being attached to a bedside cardiac monitor. The patient group requiring telemetry are children diagnosed with a known/unknown arrhythmia, children at risk of an arrhythmia, or children anticipated to be at risk of sudden cardiac deterioration. Telemetry is not a replacement for patient visualisation and assessment. Telemetry accuracy relies on skin preparation, electrode and lead placement, equipment maintenance, patient monitoring and education. Studies have shown that with appropriate education to the patient and family, patient safety is improved and anxiety associated with monitoring is reduced. Nurses who are able to identify ECG abnormalities are in prime position to prompt immediate action and lessen patient complications.

To guide safe and competent nursing and medical practice associated with the use of cardiac telemetry monitoring.

Patients should be assessed daily for the appropriateness of cardiac telemetry. Acutely unwell patients at risk of life-threatening arrhythmias should be on strict bed rest and continuously monitored on the bedside monitor and close to emergency equipment. The AUM will be involved in all aspects of care, from patient assessment and daily reviews for appropriateness of telemetry.

Patients aged 2 years and less are not recommended for telemetry. The size of the electrodes are generally too big for patients this age, and this can cause incorrect readings and problems with skin integrity. The algorithm is not strong enough to support infants and neonates (as directed by Philips).

Indications for telemetry include, in consultation with cardiology team, but not limited to;

For every patient on telemetry There should be both a daily medical and nursing assessment on the need for continuous cardiac monitoring and this should be documented daily. Exclusion criteria for telemetry, in consultation with cardiac team;

Identify and intervene in specific paediatric arrhythmias;

Telemetry set upand discontinuation

Ericksen, A. (2011). Telemetry Travels. Healthcare Traveler, 18(10), pg 35-38

Estrada et al. (2000). Evaluation of Guidelines for the Use of Telemetry in the NonIntensive-Care Setting. J med intern med. 15(1), pg 51-55

Dresslor .R, Dryer .M, Colletti .C, Mahoney .D, Doorey, A. (2014). Altering Overuse of Cardiac Telemetry in non-intensive care unit settings by hardwiring the use of American Heart Association Guidelines. JAMA intern med, 174(11), pg 1852-1854

Ivonye. C, Ohuabunwo. C, Henriques-Forsythe. M, Uma. J, Kamuguisha .L, Olejeme .K, Onwuanyi .A (2010). Evaluation of telemetry utilization, policy, and outcomes in an inner-city academic medical center. Journal of the national medical association, 102(7), pg 598- 605

Lee. J, Lamb. P, Rand. E, Ryan. C, Rubal. Optimising Telemetry Utilisation in an Academic Medical Center. B Original Research, 2008, 15(9), pg 435 439

No author (2008). Dysrhythmia Monitoring. American Association of Critical Care Nurses, 28(5), pg 90-91

Philips Healthcare (2020). IntelliVue MX40. YouTube video. https://www.youtube.com/watch?v=wpFvfzqsLRY

Philips Medical Systems (2012). IntelliVue MX40 manual. http://incenter.medical.philips.com/doclib/enc/fetch/2000/4504/577242/577243/577247/582636/582882/MX40_B.0_Service_Guide.pdf%3Fnodeid%3D10668578%26ver

View this guidelines evidence table here.

Please remember to read the disclaimer.

The development of this nursing guideline was coordinated by Annabelle Santos, CSN Nursing Education and Emily Mohd-Faizal, RN Koala, and approved by the Nursing Clinical Effectiveness Committee. Updated November 2021.

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