ST Segment Monitoring

American Association of Critical Care Nurses- August 2004Download the .pdf

Expected Practice:

  •  Use the lead that best defines the patient’s “ST fingerprint” when monitoring for acute coronary occlusion and reocclusion of the vessel following therapeutic intervention.
  • Use Leads III and V3 for ST segment monitoring for patients with acute coronary artery syndrome. Use ST segment analysis to monitor patients:
  • In the early phase of acute coronary syndromes (ST elevation for non-ST elevation MI; unstable angina/”rule out” MI).
  • Who present to the emergency department with chest pain or anginal-equivalent symptoms.
  • Who have undergone non-urgent percutaneous coronary intervention with suboptimal angiographic results.
  • With possible variant angina due to coronary vasospasm.
  • Mark electrode placement with indelible ink.
  • Establish ST level with the patient in the supine position, set the ST alarm parameter 1-2 mm above and below the patient’s baseline ST level and measure ST segment changes 60ms beyond the J point of the ECG complex.
  • Properly prepare the patient’s skin before attaching the ECG electrodes.

Supporting Evidence

  •  Use the lead that best defines the patient’s “ST fingerprint” when monitoring for acute coronary occlusion and reocclusion of the vessel following therapeutic intervention.
  • Use Leads III and V3 for ST segment monitoring for patients with acute coronary artery syndrome. Use ST segment analysis to monitor patients:
  • In the early phase of acute coronary syndromes (ST elevation for non-ST elevation MI; unstable angina/”rule out” MI).
  • Who present to the emergency department with chest pain or anginal-equivalent symptoms.
  • Who have undergone non-urgent percutaneous coronary intervention with suboptimal angiographic results.
  • With possible variant angina due to coronary vasospasm.
  • Mark electrode placement with indelible ink.
  • Establish ST level with the patient in the supine position, set the ST alarm parameter 1-2 mm above and below the patient’s baseline ST level and measure ST segment changes 60ms beyond the J point of the ECG complex.
  • Properly prepare the patient’s skin before attaching the ECG electrodes.

What You Should Do:

  •  When replacing current ECG monitoring equipment, consider equipment that has ST segment monitoring capabilities.
  • Review organization policies and procedures related to cardiac monitoring to assure same standard of care across settings.
  • Develop proficiency standards for all staff involved in the monitoring process to ensure patient safety and effective monitoring.
  • Provide appropriate ECG education for staff.
    • Include didactic content and “hands-on” practice with return demonstration of lead placement
  • Conduct an audit on determining appropriate leads to use for ST segment monitoring and appropriately setting ST alarm parameters.
  • If compliance for either is <90%, develop a plan to improve compliance: Consider forming a multidisciplinary task force (nurses, physicians, respiratory therapist, monitor technician) or a unit core group of staff to address ECG monitoring practice changes.
    • Educate staff about the significance of correct placement of electrodes and skin preparation.
    • Incorporate content into orientation programs, initial and annual competency verifications.
    • Develop a variety of communication strategies to alert and remind staff of the importance ECG monitoring.

Need More Information or Help?

Talk with a clinical practice specialist for additional information / assistance at www.aacn.org then select PRN.

References:

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Other Articles of Interest:

Daleiden AM & Schell H. Setting a new gold standard: ST segment monitoring provides early detection of myocardial ischemia. Am J Nurs. 2001 May; 101 (Supp): 4-8.
Drew BJ. Celebrating the 100th birthday of the electrocardiogram: Lessons learned from research in cardiac monitoring. Am Crit Care. 2002 Jul;11(4):378-388.