Continuous ECG monitoring in hospital: part 2, practical issues

Continuous monitoring of the electrocardiogram (ECG) is a common intervention performed by cardiac nurses. In the first article of this two-part series, we evaluated the principal indications for ECG monitoring. These are the detection of arrhythmias, monitoring for myocardial ischaemia, and measurement of the QT interval. In this second article, the practical issues surrounding ECG monitoring are evaluated. The use of 3- and 5-electrode systems is discussed, and is related to ECG theory and normal coronary artery anatomy. Recommendations are made for lead selection, correct electrode placement, and the recording of 12-lead ECGs. The article concludes with a consideration of safe practice in respect of alarm management, and considers both individual and organisational approaches to reducing inappropriate alarms.