Continuous ST segment monitoring

[enterprisern]

[COLOR=#000000] [/COLOR][COLOR=#000000]I am working on an educational program and standard work for dealing with continuous ST segment monitoring for our patients in SICU. Does anybody's facility do continuous ST monitoring on the CV postop patients and or vascular postop patients?. If so, could you answer some questions for me: 1. What were the perceptions or attitudes of the staff when told that this practice standard would be added to their patient care? 2. How often do the nurses document ST segment measurement or is it done by the telemetry monitor technician? 3. Do you chart hourly along with posting a strip? 4.. How long do you monitor ie, do you chart 24 or 48hours postop? 5.Is the competency completed by ICU nurses on orientation, annually, etc. 6. Is the practice audited for compliance? Again, thank you for the information. [/COLOR]

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[JeffTheRN]

I am interested in the responses to this as well. We have ST monitoring capabilities, however, it is not utilized in our facility.

[Okami_CCRN, BSN, RN]

Our monitors have the capability to do both ST segment monitoring and QTc monitoring. The CCU primarily handles ST segment monitoring in the ICU we use QTc monitoring usually for those who have overdosed on drugs known to prolong the interval.

I have noticed that with ST segment monitoring for it to be accurate the leads MUST be placed appropriately if not alarms are going off every minute because it may be falsely elevated.

[travelingrn2001, ASN, BSN]

Although I understand some of the benefits of continuous ST segment monitoring and QTc, I feel that our facility continues to struggle with alarm fatigue. Until the reliability of these alarms increases so that the alarms do not add to the already high number of false alarms, I feel that these automatic systems should not be implemented.

[SummitRN, BSN, RN]

In my opinion, continuous ST segment monitoring on patients who are not at heavily sedated, if not paralyzed, produces in useless results (because you can't run with the filters off on patients who move around and the filters alter the tracing and thus the computed ST voltage) and alarm fatigue that the ST segment monitoring is worthless at best and dangerous at worst.

I know this because I tried to use it and I do alarm analytics to reduce alarm fatigue.

Instead we do scheduled 0600 12 leads + ad-hoc intermittent telemetry ST checks via temporarily turning off the filters then follow with a prn 12 lead as indicated. Compliance on the daily 12 lead is good. Compliance on the intermittent checks is poor (unless there are symptoms) and unmonitored.