Before learning nursing, I often saw in serials or movies that patients in the hospital had a lot of lines and tubes attached to their bodies. I didn’t understand what these were for. I only knew that they were assisting patients in their treatment.
After studying nursing, I realized that this is a Patient Monitor, which can help medical staff to observe the patient's ECG, blood pressure, respiration, pulse and other actual parameters at any time, which is conducive to timely detection of the disease. Thereby arousing the attention of medical staff and intervening in time.
It is widely used clinically, and it is more common in patients with serious illness and critical illness. Therefore, the use and operation of the monitor is a necessary skill for every medical staff.
So, do you understand the routine operation, connection, maintenance and troubleshooting of the monitor? If you still have any questions, please read this article carefully!
Operating points
What is the difference between 3-lead and 5-lead ECG leads?
The 3-lead ECG lead can only obtain the I, II, and III leads, while the 5-lead ECG lead can obtain the I, II, III, AVR, AVF, AVL, and V leads.
In order to facilitate quick connection, we use the color marking method to quickly paste the electrode pads at the corresponding positions.
3-lead ECG leads are marked in red, yellow, green or white, black, red;
The 5-lead ECG leads are color-coded white, black, red, green, and brown.
The positions of the electrode pads placed on the wires of the same color in the two specifications of leads are not the same. The English abbreviations RA, LA, RL, LL, and C are used to determine the position than to memorize the color.
Why is it recommended to wear blood oxygen saturation finger cuffs first?
Because wearing a blood oxygen saturation finger cuff is much faster than connecting an ECG lead wire, the patient's pulse rate and blood oxygen saturation can be monitored in the shortest time, and medical staff can quickly complete the assessment of the patient's most basic signs.
Can the SpO2 finger cuff and blood pressure cuff be placed on the same limb?
Arterial blood flow will be blocked during blood pressure measurement, resulting in inaccurate blood oxygen saturation monitored during blood pressure measurement. Therefore, it is not recommended clinically that blood oxygen saturation finger cuffs and automatic sphygmomanometer cuffs be placed on the same limb .
For patients under continuous ECG monitoring, should electrode pads be replaced?
It needs to be replaced, because the electrode pads are pasted on the same part for too long, which will lead to rashes and blisters, so the skin condition should be checked frequently . The occurrence of skin breakage in the patient.
After stopping the ECG monitoring, remember to take out the electrode pads.
What should be paid attention to in non-invasive blood pressure monitoring?
1. Pay attention to avoid blood pressure monitoring on internal fistula limbs, hemiplegic limbs, limbs in the same direction of patients with breast cancer resection, infusion limbs, and limbs with edema, hematoma and skin damage. It is also necessary to pay attention to patients with poor coagulation function and sickle cell disease to avoid medical disputes caused by blood pressure measurement.
2. The measurement part should be replaced routinely, and experts suggest changing it every 4 hours . Avoid continuous measurement on one limb, resulting in purpura, ischemia, and neurological damage in the limb rubbed against the cuff.
3. When measuring adults, children, and newborns, pay attention to the selection and adjustment of cuffs and pressure values. Because the pressure applied to adults is used in children and newborns, it will threaten the safety of children; and when the instrument is set on newborns, the blood pressure of adults cannot be measured.
There is no module for monitoring breathing on the monitor. How is breathing monitored?
The respiration on the monitor relies on the electrode pads of the electrocardiogram to sense the impedance changes of the thorax and display the waveform and data of respiration.
Because the electrodes on the lower left and upper right are breath-sensing electrodes, their placement is very important. The two electrodes should be placed diagonally as much as possible to obtain the best breathing wave.
If the patient mainly takes abdominal breathing, stick the lower left electrode to the most obvious ups and downs of the left abdomen.
Each parameter has an alarm range, how to set it?
Principles of alarm setting: ensure the safety of patients, minimize noise interference, and do not allow the alarm function to be turned off, unless it can be temporarily turned off during rescue. The setting of the alarm range is not a normal range, but a safe range.
Alarm parameters: heart rate is 30% above and below the heart rate; blood pressure is set according to the doctor's order, the patient's condition and basic blood pressure; oxygen saturation is set according to the condition; the alarm volume must be heard within the nurse's working range; the alarm range should be at any time according to the situation Adjust and check at least once per shift.
What should I do if the waveform of the monitor does not come out?
1. check, 2. rule out, 3. pay attention
examine
First confirm whether the electrode pads are properly pasted , check the location of the cardiac electrode pads , check the quality of the cardiac electrode pads, and check whether there is any problem with the lead wire on the basis that the electrode pads are pasted and there is no problem with the quality.
Check that the connection steps are correct, check whether the operator's lead mode is connected according to the connection method of the ECG monitor, and avoid the lazy and trouble-free method of only connecting five connections and only three connections.
After troubleshooting the ECG cable failure, if the waveform still does not come out, it may be that the "ECG signal line" on the parameter socket board is not in good contact , or the ECG board, the main control board connection line of the ECG board, and the main control board are faulty.
exclude
1. Check all the external parts of the ECG leads (the three/five extension lines in contact with the human body should be connected to the corresponding three/five contact pins on the ECG plug. If the resistance is infinite, it means that the lead wires are broken. lead wire should be replaced). Method: Take out the ECG lead wire, align the protruding side of the plug of the lead wire with the groove of the "ECG" jack on the front panel of the host,
2. This ECG cable can be exchanged with other machines to confirm whether the ECG cable is faulty, whether the cable is aging or the pin is damaged .
3. If the waveform channel of the ECG display shows "no signal reception", it means that there is a problem with the communication between the ECG measurement module and the host, and the prompt still exists after turning off and on again, and you need to contact the supplier.
Notice
1. The connection steps must be correct:
① Wipe the 5 specific positions of the human body with the sand on the electrode sheet , and then use 75% ethanol to clean the surface of the measurement part, in order to remove the cuticle and sweat stains on the human skin and prevent poor contact of the electrode sheet.
② Fasten the electrode head of the ECG lead wire with the electrodes on the 5 electrode pads .
③ After the ethanol has evaporated, paste the 5 electrode sheets on the specific positions after cleaning to make the contact reliable and not fall off.
2. Do a good job in publicizing and educating patients and their families:
Instruct patients and other personnel not to pull the electrode wires and lead wires, and inform patients and relatives not to use or adjust the monitor without authorization, causing damage to the device. Some patients and their family members have a sense of mystery and dependence on the monitor, and the oscillometric changes of the monitor will cause them anxiety and panic. Nursing staff should make sufficient and necessary explanations to avoid interfering with normal nursing work and affecting the relationship between nurses and patients.
3. Pay attention to the maintenance when using the monitor for a long time
The electrode pads are easy to fall off after long-term use, which affects the accuracy and monitoring quality. Change it every 3 to 4 days ; at the same time, check and pay attention to the cleaning and disinfection of the skin, especially in the hot summer.
4. Professionals review and repair
If a serious abnormality is found during the monitoring process, it is best to ask professional personnel in the electrocardiogram room to review and diagnose, and the manufacturer's maintenance personnel to perform professional maintenance.
5. Connect the ground wire when connecting
Method: When grounding the wire, connect the end with the copper sleeve to the grounding terminal on the rear panel of the host. (The method is to unscrew the knob cap of the grounding terminal, put the copper sleeve on, and then tighten the knob cap). The other end of the ground wire has a clip, please clip it to the public ground terminal of the building facilities (water pipes, radiators, etc. that are directly connected to the earth).
