Cardiac Monitoring of Pediatric Patients in Med Surg

[Vicki_RN]

Hi,

I am collecting data regarding the community standard for the use of a cardiac monitor, central or bedside, in the general pediatric hospital care areas. For those who work in a NON-ICU pediatric patient care floor, do you provide cardiac monitoring, is it central or just at the bedside, and which patients are considered for monitoring? I promise to post the numbers once I get replies for others who may be interested. Thank you for you help!

[KelRN215, BSN, RN]

Central and bedside. Part of admission orderset, pretty much all patients would get ordered for it.

[NotReady4PrimeTime, RN]

All of our peds inpatient beds are monitored, centrally and at the bedside. And the data from our PICU monitors transfers.

[hiddencatRN, BSN, RN]

Same as KelRN215. If we have a patient who doesn't need monitoring we get an order for that. Central and bedside monitors.

[NicuGal, MSN, RN]

Central monitoring and all get monitors unless ordered not to.

[~PedsRN~, BSN, RN]

We monitor centrally and at the bedside as well, but we do require a doctor's order for monitoring. A patient can be ordered for cardio-respiratory monitoring as well as pulse oximetry.

I hate cardiac monitors. The guy who invents a set of monitors that works on an infant/toddler reliably will be RICH!!!

A baby being burped looks JUST like VTach. :)

[jrt4]

I am actually surprised that most of you say that you use them on all patients. I work general pediatrics and pediatric ICU. We only use them routinely in the PICU. They are very unreliable on general pediatrics because those kids are usually mobile and pulling at the leads (and burping into "VT" as someone put it haha). I just created an evidence based protocol for our bronchiolitis patients and from the research I read putting patients on monitors actually increases length of stay. I would discourage putting general pediatric patients on full cardiac monitor because it is unnecessary and just creates more work/stress for both the nurse and the patient. In our facility if a patient requires CR monitoring we usually transfer to PICU. This is just my opinion.

[hiddencatRN, BSN, RN]

So you'd send a patient on continuous albuterol to PICU?

[wooh, BSN, RN]

Why would you put a continuous albuterol on a cardiac monitor? I'm guessing it will show a shocking rhythm that's tachy! And we'll do NOTHING for that because it's expected. Frequent checks are more than adequate for a continuous albuterol treatment.

Central monitors should be available. They should be used a lot less than they are. More than 99% of monitor beeps on a non-ICU peds floor are because you've put leads on a moving kid. It just camouflages when a kid that should actually be on monitors has something happen. I've watched the monitor screen have 10+ monitors going off, and not a single one was "real." Add an apnea baby to the mix and you'll have no idea they're having apnea because you've got 15 toddlers toddling their leads around. Peds is an area ripe for monitor fatigue because kids are NOT going to be mindful of the leads like adults usually can be.

[Kunzieo]

We have a peds "Floor" and a PICU.

Any child requiring cardiac monitoring for any reason gets admitted/transferred to the PICU. We do NOT do cardiac monitoring on the Floor.

[hiddencatRN, BSN, RN]

Continuous albuterol can cause dysrhythmias. We adjust the limits to account for the expected tachycardia. But frequent runs of bigeminy and trigeminy are a concern. I agree that CR monitors are overused, but a patient on continuous albuterol is one I want a continuous rhythm on.

[PICUisforcoolRNs]

Any peds patients that require cardiac monitoring come to our PICU as well or (more rarely) the step down unit. The general peds floor will monitor oxygen saturation, but they have no central monitoring system.

Side note: any kiddos on continuous albuterol for >4 hours equals PICU for us. Not for tachycardia, but to closely monitor their respiratory status