User Manual

SKIN PREPARATION AND LEAD PLACEMENT
PatientNet Operator’s Manual, v1.04, 10001001-00X, Draft 43
All information contained herein is subject to the rights and restrictions on the title page.
SKIN PREPARATION AND LEAD PLACEMENT
Patient Preparation for Monitoring
The single most important factor for accurate computerized arrhythmia monitoring is
the quality of the ECG signal.
Electrode application is the critical step. Prepare the patient’s skin to provide for good
adherence of the electrode. This may seem time-consuming, but if done meticulously
in the beginning to decrease skin impedance in the skin/electrode interface, much
effort will be saved later. This step contributes greatly to the acquisition, analysis, and
archival of accurate information in arrhythmia monitoring.
Each patient must have their individual monitoring needs met. Appropriate lead place-
ment and selection is critical to this outcome.
Check the quality of the ECG signal. Four characteristics are essential:
• Artifact free
• Continuous
• Adequate signal strength
• Leads securely attached
If artifact is present, then the monitor will not be able to establish a good ECG refer-
ence in the learn mode and will have difficulty assessing the rhythm. If lead wires are
broken, or the electrode contact is poor, then the signal will be interrupted. This may
result in check signal, no signal, or false positive calls. Finally, if the signal does not
have a minimum amplitude of reasonable size (0.5 mV), then it may not be recognized
by the QRS detector and will result in false asystole calls. It is essential that the QRS
amplitude exceed the P-wave amplitude. If the P-wave amplitude is too high, then the
system may detect the P-wave instead of the QRS.
Computerized systems use mathematical descriptions of QRS complexes to assign
arrhythmia categories. Motion artifact is mathematically similar to QRS complexes,
but occurs less regularly in time and can therefore be misidentified as aberrant beats,
V-FIB, or V-TACH.