Definition and Overview
Heart telemetry and recording is a procedure used to monitor the electrical activity of the heart. It is performed with the use of a special device that monitors all cardiac events, including every heartbeat, over an extended period. The events are then recorded and transmitted to a monitoring center, usually a nursing station, via a cellular network. Once the monitoring center receives the signals, the information is then interpreted.
The use of a cardiac monitor is meant to help diagnose heart problems particularly those that affect the beating of the heart and determine the appropriate treatment plan for the patient.
Who Should Undergo and Expected Results
Given its specific features, heart telemetry and recording is appropriate for patients who:
Are suspected or diagnosed of having an arrhythmia
Are at risk of arrhythmia
Are at risk of sudden cardiac deterioration
This type of heart event monitor can be used on children aged 2 years and older for the diagnosis and monitoring of pediatric arrhythmias and conditions related to them, which include:
However, the use of a telemetry device is not recommended for young patients under age 2 and adult patients who suffer from certain health conditions, including:
Fluid buildup in the lungs
Any ongoing or recent injury
It is also not recommended for patients who are taking medications that help regulate their heartbeat.
Heart telemetry is not the only way to record a person’s heartbeat over an extended period. However, it does hold several key advantages over other types of cardiac event recorders. For one, a telemetry device is easier to use and is more convenient. The patient can wear the heart telemetry monitor in the hospital or at home and without being hampered or hindered by it, unlike the alternative Holter monitor.
A heart telemetry and recording is expected to help doctors continuously monitor all of a patient’s cardiac activities for a long time. This is why it is the cardiac event monitoring option of choice for patients who are experiencing symptoms on a less frequent and less predictable manner. Due to the continuous monitoring, the device can detect even symptoms that only occur occasionally. This information can help doctors detect a heart problem early and enable the patient to get help as soon as possible. This may make a key difference in the patient’s long-term prognosis.
How is the Procedure Performed?
A heart telemetry and recording is performed through a series of steps, all of which may affect the accuracy of the transmitted results. Thus, the procedure should only be performed by a trained technician.
The steps include the following:
1.) Skin preparation. Prior to the placement of the telemetry device, the doctor or cardiac technician first prepares the patient’s skin by cleaning it thoroughly. The telemetry’s electrodes are commonly placed on the chest, stomach, arms, and legs. Each electrode has a wire that connects it to a small device, which is responsible for transmitting signals to the monitoring center. The skin should be clean and dry so that the electrodes will adhere better and thus provide more accurate results.
2.) Electrode placement. To ensure that the electrodes maintain their optimal conduction and are thus capable of producing the correct results, they should be replaced daily. This helps prevent skin breakdown, which may allow the leads to become misplaced. Also, to ensure best results, doctors commonly use a specific type of electrode, namely the Covidien Kendall 130 foam electrodes.
The function of the telemetry also depends on the different leads used on the electrodes. For the procedure to work, there should be 5 leads, namely:
White or RA (right arm) – This is placed near the right shoulder, specifically in the infraclavicular fossa.
Black or LA (left arm) – This is placed on the other side of the infraclavicular fossa near the left shoulder.
Red or LL (left leg) – This is placed on the upper left part of the abdomen, just below the rib cage.
Green or RL (right leg) – This is placed on the upper right part of the abdomen, also below the rib cage.
Brown or V1 – This is also placed just below the rib cage, in between the RL and the xiphoid process
Patients with a permanent pacemaker may also use a heart telemetry device if necessary. The device has a specific monitor setting called “paced”, which allows it to pick up the spikes in cardiac activity caused by the pacemaker.
The placement of the electrodes is also affected by the patient’s specific health condition. For example, patients who are diagnosed with dextrocardia should have their leads swapped. If not, the results of their ECG will become inverted.
3.) Telemetry setup. The doctor placing the telemetry device will then set up the telemetry device from the central monitor, wherein lead 1 is used to diagnose QRS complex and lead 2 is used to monitor the patient’s heart rate and diagnose atrial activity. To check if the device is working properly, the doctor may take the patient’s heart rate manually then compare it with the device’s reading. In case the device is double counting the heart rate, the doctor can select a different primary lead.
4.) Monitoring. Although it can be used continuously over an extended period of time, doctors typically conduct an initial monitoring that ranges from 24 hours to over 72 hours. This can then be extended depending on the patient’s condition.
5.) Maintenance. Prior to sending the patient home with the device, the doctor first makes sure that the device’s battery is fully powered and is functioning properly. He will also check if all the wires are properly connected.
Possible Risks and Complications
The primary risk that comes with cardiac event monitoring systems like heart telemetry and recording is overuse in low-risk patients who don’t really require it. In such cases, the use of telemetry recording only entail unnecessary cost and may also affect patient safety. Thus, if patients have low-risk chest pain, the cardiac event monitor’s cost and potential benefits should be carefully compared first. Such patients only have rare significant heart events, so the results offered by telemetry may not have a significant impact on their cardiac management plan.
Also, despite its ability to continuously monitor a patient’s heart condition, it should not replace physical visualization and assessment. The doctor should still make sure to physically assess the patient’s condition regularly.
The use of event monitors such as telemetry devices at home also come with its own risks. For one, the device may cause some anxiety among the patient’s family members. Thus, it is recommended that patients and their family members be appropriately educated regarding the use of the device in order to improve patient safety.
In the event that a patient becomes unstable while being monitored via heart telemetry, he or she should then be placed on a continuous bedside monitoring system.
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1309575 Mohammad MM, John S. “Cardiac telemetry 2016: An overview of guidelines and clinical practice.” Ibnosina Journal of Medicine and Biomedical Sciences. 2016. Vol. 8 no. 6. http://journals.sfu.ca/ijmbs/index.php/ijmbs/article/view/637
Benjamin EM, Klugman RA, Luckmann R, Fairchild DG, Abookire SA. “Impact of cardiac telemetry on patient safety and cost.” American Journal of Managed Care. 2013 June 11. http://www.ajmc.com/journals/issue/2013/2013-1-vol19-n6/impact-of-cardiac-telemetry-on-patient-safety-and-cost