Non-Invasive Monitoring Pearls

Non-Invasive Patient Monitoring

Purpose:        

Non-invasive patient monitoring includes ECG’s, blood pressure, pulse-oximetry, capnography and blood CO levels. It is an essential tool for the initial assessment of patients and for ongoing evaluation and treatment. It is desirable that there be a consistent and reliable method of applying these tools to the patient in the pre-hospital environment as well as a common understanding of the limitations of these devices. This guidance seeks to provide a reference for all providers to assist in the consistent application of these tools and a resource for trouble shooting common problems.

Policy:            

The following procedures will be used when applying non-invasive monitoring tools to patients.

Procedure:

General:

·         All equipment will be in an organized condition suitable for immediate deployment.

·         All exterior surfaces and lead sets will be cleaned and disinfected after every use

ECG’s:

·         All ECG’s will be obtained using undamaged electrodes from a sealed package.

·         4 lead ECG’s will utilize limb leads and be placed on the extremities on the inside of the wrists and ankles so as to avoid muscle and fatty tissues.

·         12 lead ECG’s will be obtained using both limb leads and standard 12-lead placement on the chest wall.

·         Clothing will be removed as required to obtain correct lead placement.

·         ECG quality will be best if performed in a stationary location with the patient as still as possible.

Blood pressure:

·         Obtaining a manual blood pressure for reference is desirable but should not delay patient assessment or care.

·         Correct cuff size is important both in width and length, the correct cuff can be fastened securely around the upper arm without extending into the armpit or covering anticubital fossa.

·         In cases where the upper arm cannot be used due to size and/or anatomy, the lower arm or thigh may be used. If an alternative location is used it must be documented with the blood pressure.

·         Limbs which are injured, amputated or contain fistulas should not be used.

·         While blood pressures are being obtained the patient should remain still and the cuff  and tubing should be free of any pressure points.

Pulse-oximetry/CO monitoring:

·         Never delay treatment to obtain pulse-oximetry

·         Finger probes shall be applied to clean, uninjured digits without fake nails and/or nail coatings.

·         Pulse-oximetry will not be reliable in patients with decreased peripheral circulation due to hypovolemia, shock, or temperature.

·         Environmental light sources may interfere with the device, blocking the light source by placing a wash cloth or towel over the probe may improve the quality of the signal.

·         If the patient has cold hands, placing a hot pack in the hand may improve the circulation and the quality of the signal.

Capnography:

·         All patients with an altered LOC, respiratory distress, suspected shock/sepsis and traumatic chest injury should receive capnography.

·         All patients who are intubated, have an advanced airway or receiving ventilatory support should receive capnography.