( A ) Use object.
Any patient whose condition is critical and requires continuous uninterrupted monitoring of the frequency and rhythm of the heartbeat and body temperature, respiration, blood pressure, pulse rate and transcutaneous oxygen saturation.
( 2 ) ECG monitoring operation procedures.
1. Preparation items. The main items are ECG monitor, ECG blood pressure plug-in connection lead, electrode piece, saline cotton ball, matching blood pressure cuff.
2, operating procedures are as follows.
3. Connect the power supply of the ECG monitor.
4. Place the patient in a flat or semi-recumbent position.
5. Turn on the main switch.
6. Use saline cotton ball to wipe the patient’s skin at the electrodes on the chest.
7. Attach the electrode piece, connect the ECG lead wire, and the ECG wave appears on the screen.
8. Tie the cuff to two fingers above the elbow fossa. Press measurement – set alarm limit – measurement time .
( 2 ) The electrodes usually used in the use of ECG monitor and the placement of each electrode.
There are five electrodes placed as follows.
Upper right (RA): First intercostal space on the midclavicular line at the right edge of the sternum.
Lower right (RL): right midclavicular line at the level of the fenestra.
Middle (C): the fourth intercostal space on the left edge of the sternum.
Upper left (LA): first intercostal space in the midclavicular line of the left sternal border.
Left lower (LL): at the level of the fenestra of the left midclavicular line.
( 3 ) The main observation indexes when monitoring the ECG in the monitoring system.
1. Observe and record the heart rate and rhythm regularly.
2. Observe whether there is P wave, the shape, height and width of p wave.
3. Measure the p-R interval and Q-T interval.
4. Observe whether the QRS waveform is normal and whether there are “missed beats”.
5. Observe whether the T wave is normal.
6. Pay attention to the presence of abnormal waveforms.
Blood pressure monitoring: 1.
1. Main function: It is divided into automatic monitoring, manual monitoring and alarm device. Manual monitoring is to use at any time to start the START key; automatic monitoring can be timed, manually set the interval, the machine can automatically monitor according to the set time.
2, the use of blood pressure monitor should pay attention to the following: first, should pay attention to each measurement should be drained of residual gas in the cuff, so as not to affect the measurement results. Second, choose a suitable cuff.
Transcutaneous oxygen saturation monitoring.
1, Use the infrared probe of transcutaneous oxygen saturation monitor fixed on the patient’s finger end to monitor the percentage of oxygenated hemoglobin to hemoglobin when the small artery at the patient’s finger end is pulsating.
2. Cautions: First, the probe should be fixed when used and the patient should be kept as quiet as possible to avoid alarm and non-display of results. Second, the accuracy of the results can be affected when the peripheral circulation is poorly perfused such as severe hypotension and shock.
( 3 ) Precautions
1, in the monitoring alarm such as the oscilloscope screen shows a line or oxygen saturation is not displayed can be considered.
2. Whether the power cord is malfunctioning or the patient’s heartbeat has stopped.
3. Whether the electrode or probe is dislodged.
4, the nurse first observe the patient’s condition, whether the heart rate is too fast with fluid speed, fever or general dryness; heart rate is too slow with apnea, shallow breathing related.
5. To remove disturbances: _
6. The child should be lying down, and the electrode plate should be tightly attached.
7. The monitor should be placed away from the wall.
8. The bed and the patient should be away from the wall.
9. Other electrical appliances should be at a certain distance from the monitor.
10. Ground wire must be completely grounded to avoid leakage of electricity from the machine, affecting personal safety.
11. The monitor screen should be wiped with 95% alcohol cotton ball every week.
Precautions for ECG monitoring
I. Precautions for ECG monitoring.
1, remove the ECG lead wire, the lead wire plug convex surface aligned with the host front panel “ECG” jack notch, insert can
2, the other end of the ECG lead wire with 5 electrode tips and the body to be measured for connection, the correct connection steps are
a. Clean the surface of the measurement site with 75% ethanol to remove the keratin layer and sweat stains on the human skin to prevent poor contact with the electrode piece.
b.The electrode head of the ECG lead wire is fastened with the electrode buckle on the 5 electrode pads.
c.After the ethanol evaporates cleanly, stick the 5 electrode pieces to the specific position after cleaning so that the contact is reliable and does not fall off.
d.Clamp the lapel clip on the lead wire in the bed to fix it. And instruct the patient and medical staff not to pull the electrode wire and lead wire.
3. Make sure to connect the ground wire, which will play a very important role in the normal display of the waveform.
2.Cautions when monitoring blood oxygen.
1, the plug of the oxygen probe and the host panel “oxygen” jack must be plugged in place. Otherwise, it may not be able to collect oxygen information and display the oxygen value and pulse rate value.
2. The patient’s nails must not be too long, and must not have any stain, dirt or gray nails. If the patient’s finger feels discomfort after a long period of oxygen monitoring, it should be replaced with another finger for monitoring.
3.Patients and health care workers should not collide and pull the probe and wire to prevent damage and affect the use.
4.The oxygen probe should be placed separately from the blood pressure measurement arm, because when the blood pressure is measured, the blood flow is blocked, and the blood oxygen cannot be measured at this time, and the screen shows the word “oxygen probe off”.
C. Precautions for blood pressure monitoring
The connection between the blood pressure cuff and the patient is different for adults, children and newborns, and different specifications of the cuff must be used.
1, the cuff should be unfolded and wrapped around the patient’s elbow joint 1 to 2cm, the degree of elasticity should be able to insert 1 to 2 fingers appropriate. Too loose may lead to high pressure measurement; too tight may lead to low pressure measurement, while making the patient uncomfortable and affecting the patient’s arm blood pressure recovery. The catheter of the cuff should be placed at the brachial artery and the catheter should be on the extension line of the middle finger.
2, the arm should be kept flush with the person’s heart, and the patient should be asked not to speak or move around when the blood pressure cuff is inflated.
3.When measuring the blood pressure, the position of the cuff on the arm should be kept flush with the heart, and the patient should not speak or move.
4.The arm should not be used to measure the temperature at the same time, it will affect the accuracy of the temperature value.
5.It should not be used for drip or malignant trauma, otherwise it will cause blood reflux or wound bleeding.
6, in general, the first pressure measurement value is only for reference
V. Notes on external power supply.
1.The texture of the distribution box should be excellent and reliable, and the plug should be firmly connected. In order to avoid poor plug contact, so that the host can not work properly, or even cause damage to the host power supply.
2, the principle of uninterrupted and stable power supply.
Easy to ignore in the use of cardiac monitors
1 Blood pressure monitoring in the easy to ignore aspects
1, 1 cuffs should be more than one, the number of adequate, complete models and sterilization spare. Do special use. Even if there is a shortage of instruments and a monitor is shared between adjacent beds, the cuff should be fixed and applied, and the joint part of the cuff can be replaced during measurement. This can effectively avoid cross-infection and prevent the resulting psychological discomfort to patients and their relatives.
1,2 Patients who are continuously monitored must be relaxed 1-2 times per shift. When the condition allows, it is best to change the monitoring site once at an interval of 6-8h. To prevent continuous monitoring of the same site, the patient caused by unnecessary skin damage.
1, 3 continuous use of more than 3, days of patients, pay attention to the replacement, cleaning and disinfection of the cuff. It can both prevent odor and increase comfort.
1.4 When the nylon buckle of the cuff is loose, it should be replaced and repaired in time. To prevent increased errors.
1.5 When measuring adults and children, pay attention to the selection of cuff and pressure value adjustment to avoid confusion.
1.6 Do not measure too frequently when the patient is agitated or in physical spasm when there is a large error in the measured value. In case of severe shock or heart rate less than 40 beats per minute or more than 200 beats per minute, the measured results should be compared with the manual measurement results and combined with clinical observation.
2 Oxygen saturation and heart rate measurement are easy to ignore
2, 1
2.2 Pay attention to the care of the probe; fix it with adhesive tape; avoid collision, dislodgement and damage; cause unnecessary waste.
4
4.1 The electrode piece is easy to fall off in long-term application, which affects the accuracy and monitoring quality. 3-4d replace once; and pay attention to the cleaning and disinfection of the skin.
4.2 When serious abnormalities are found in monitoring, it is better to ask professional ECG room personnel to review and diagnose; improve the accuracy of diagnosis.
5 Do a good job of explaining to patients and relatives
5.1 Most patients and relatives have a great degree of curiosity, mystery and dependence on the monitor. The slightest change in the monitor will cause anxiety, surprise and panic. This is especially true for critically ill patients. At the beginning of the application of the best to do a good job, the necessary explanation. Avoid disputes, interfere with the tense and orderly nursing work, and affect the nurse-patient relationship. Professional, and difficult to explain clear, may wish to politely decline, there are questions and answers is not appropriate at this time.
5,2 Instruct patients and relatives should not apply or adjust the monitor without permission, causing damage to the instrument.
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Troubleshooting
1, no display on the power
Fault phenomenon: when the instrument is turned on, the screen does not display, the indicator does not light; external power supply, the battery voltage low alarm, and then the machine automatically shut down; not external battery, the battery voltage low alarm, and then automatically shut down, even to the machine charging is useless.
Check method.
① in the case of the instrument did not pass AC power, check whether the 12V voltage is low. The fault alarm indicates that the output voltage detection part of the power supply board detects low voltage, may be a fault in the detection part of the power supply board or power supply board output failure, may also be caused by the failure of the back-end load circuit.
② When there is a battery installed, this phenomenon indicates that the monitor works in the battery-powered state and the battery power is basically used up, the AC input is not working properly. Possible reasons are: 220V power outlet itself is not powered, or fuse blown.
③ When there is no external battery, it may be judged that the rechargeable battery is bad, or the power board / charging control board failure caused by the battery can not be charged.
Exclusion method: Connect all the connected parts reliably, connect AC power to the instrument charging.
2.White screen, splash screen
Fault phenomenon: the power on the display, but there is a white screen, the flower screen.
Check method: white screen, splash screen shows that the display has inverter power supply, but no main control board display signal input. Can be in the back of the machine VGA output port external display, if the output is normal, may be bad screen or screen to the main control board wiring poor contact; if the VGA output, may be the main control board failure.
Exclusion method: replace the monitor, or check whether the main control board wiring is stable. vga no output, need to replace the main control board.
3.ECG no waveform
Fault phenomenon: connected to the lead wire and no ECG waveform, the display shows “electrode off” or “no signal received”.
Check method: Firstly, check the lead mode, if it is a five-lead mode but only a three-lead connection is used, there must be no waveform.
Secondly, under the premise of confirming the position of the electrode pads and the quality of the electrode pads, interchange the ECG cable with other machines to confirm whether the ECG cable is faulty, whether the cable is aging or the pins are broken.
Again, if the ECG cable failure is ruled out, the possible cause is the poor contact of “ECG signal line” on the parameter socket board, or the ECG board, ECG board main control board connection line, main control board failure.
Exclusion methods.
(1) check all the external parts of the ECG leads [contact with the human body three / five extensions to the corresponding three / five pins on the ECG plug should be open, if the resistance is infinity indicates that the lead wire is broken, then the lead wire should be replaced].
(2) If the ECG display waveform channel shows “no signal reception”, it means that the ECG measurement module has communication problems with the host, and there is still this prompt after the power is turned off and on again, so contact with the supplier.
4, ECG waveform confusion
Fault phenomenon: ECG waveform interference, the waveform is not standard, not standard.
Inspection methods.
(1) first should exclude interference from the signal input, such as patient movement, heart electrode piece failure, ECG lead wire aging, poor contact.
(2) Filter mode to “monitoring” or “surgery”, the effect will be better, because the filter bandwidth in these two modes is wider.
(3) If the waveform effect is also bad under surgery, please check the zero ground voltage, generally required within 5V, can pull a separate ground wire to achieve the purpose of good grounding.
(4) If grounding also does not work, it may be interference from within the machine, such as poorly shielded ECG board and other reasons. At this point, you should try to replace the accessories.
Exclusion method: adjust the ECG amplitude to the appropriate value, the whole waveform can be observed.
5, ECG baseline drift
Fault phenomenon: ECG scan baseline can not be stabilized on the display, and sometimes drift out of the display area.
Inspection methods.
(1) whether the instrument using environment is humid, whether the instrument internal moisture.
(2) Check the quality of electrode piece and whether the part of human body contacting electrode piece is cleaned.
Exclusion methods.
(1) Turn on the instrument continuously for 24 hours to drain the moisture itself.
(2) replace the good electrode sheet, clean the parts of the human body contacting the electrode sheet.
6.Breathing signal is too weak
Fault phenomenon: the screen display of the respiratory waveform is too weak, observation inconvenience.
Inspection method: Check whether the electrode piece of ECG is correctly placed, how the quality of electrode piece and whether the part of human body contacting electrode piece is cleaned.
Exclusion method: Clean the part of human body contacting electrode piece, and correctly affix the electrode piece of good quality.
7.Cardiac interference by electric knife
Fault phenomenon: the use of electric knife in surgery, when the electric knife negative plate contact with the human body electrocardiographic interference.
Check method: whether the monitor itself and the electric knife shell grounding is good.
Exclusion method: to the monitor and electric knife to install a good grounding.
8, SPO2 no value
Fault phenomenon: in the monitoring process, no blood oxygen waveform, no blood oxygen value.
Check method.
(1) change a blood oxygen probe, if it does not work may be the blood oxygen probe or blood oxygen extension cable failure.
(2) See if the model is right, Myriad’s oxygen probe is used more MINDRAY and Masimo two, incompatible with each other.
(3) See if the oxygen probe has red light flashing, if there is no flashing, the probe component is faulty.
(4) If there is a blood oxygen initialization error alarm, it is a blood oxygen plate failure.
Exclusion method: If there is no red light flashing in the finger probe, it may be a poor contact of the wire interface, check the extension cable and socket interface parts. In cold temperature areas, try not to expose the patient’s arm to avoid affecting the detection effect. Do not measure blood pressure and blood oxygen in the same arm, so that the arm is not compressed and affects the measurement.
If the waveform channel of blood oxygen display shows “no signal received”, it means that there is a problem of communication between blood oxygen module and host, please turn off and then turn on again, if there is still this prompt, you need to replace the blood oxygen plate.
9.SPO2 value is low and inaccurate
Fault phenomenon: When measuring human oxygen saturation, the oxygen value is low and inaccurate.
Check method.
(1) First of all, we must ask whether it is for a special case or universal. If it is a special case, it can be avoided by considering the precautions for blood oxygen measurement, such as patient movement, poor microcirculation, low body temperature, too long, etc.
(2) If it is common, please replace an oximetry probe, it may be caused by the malfunction of the oximetry probe.
(3) Check whether the blood oxygen extension cord is damaged.
Exclusion method: Try to keep the patient stable, once the blood oxygen value is lost due to hand movement, it can be considered normal. If the blood oxygen extension line is bad then replace one.
10.NIBP insufficiently inflated
Fault phenomenon: blood pressure measurement times “cuff too loose” or cuff leakage, inflatable pressure is not always filled up (below 150mmHg), can not be measured.
Check method.
(1) There may be a real air leak, such as the cuff, air guide tube and various joints, through the “air leak detection” can be determined.
(2) The patient mode selection is not correct, if you use the adult cuff but the patient type of the monitoring protocol is used for newborns, there may be this alarm.
Exclusion method: Replace the blood pressure cuff with a good quality or choose the right type.
11, NIBP measured value is not accurate
Fault phenomenon: the measured blood pressure value deviation is too large.
Check method: check whether the blood pressure cuff with air leakage, and blood pressure connected to the pipe interface is not air leakage, or whether it is because and auscultation method there is a subjective judgment under the difference brought about?
Exclusion method: Use the NIBP calibration function. This is the only available criterion to verify the correct calibration value of the NIBP module at the user’s site, and the NIBP is factory tested for a pressure standard deviation of 8 mmHg or less. If exceeded, the blood pressure module needs to be replaced.
12. Module communication abnormalities
Fault phenomenon: each module reported “communication stop”, “communication error”, “initialization error”.
Check method: This phenomenon indicates that the communication between the parameter module and the main control board is abnormal. First of all, re-plug the connection line between the parameter module and the main control board, if not, consider the parameter module, and then consider the main control board failure.
Exclusion method: Check whether the connection cable between the parameter module and the main control board is stable, whether the parameter module is set correctly, or replace the main control board.
The monitor plays an important role in the whole monitoring process, because the monitor is almost 24 hours continuous work, its failure rate is also high, the author in the past few years of maintenance work summed up some small experience, now its common failures and troubleshooting methods are described below.
1 No display on the power Source: Medical Education Network
Fault phenomenon: when the instrument is opened, the screen does not display, the indicator does not light.
Check method: (1) in the case of the instrument did not pass AC power, check whether the rechargeable battery is depleted or damaged. (2) In the case that the instrument is connected to AC power, check whether the power socket and the socket connected to the instrument are in good contact, whether the power cord is disconnected, and whether there is AC output [Medical Education Network].
Solution: Connect all connected parts reliably and turn on AC power to charge the instrument.
2 No signal
Fault phenomenon: connected to the lead line and no ECG waveform, the display shows “LEAD OFF” or “NO SINGAL”? [Medical Education Network]
Checking method: Check whether there is a battery in the transmitter box and whether the battery polarity is correct. （Is the lead wire (telemetry) disconnected.
Solution: Check all the ECG lead external parts in contact with the human body three/five extension wires to the corresponding three/five contact pins on the ECG plug should be conductive, if the resistance is infinity indicates that the lead wire is disconnected, then the lead wire should be replaced.
3 Baseline drift [MedEducation.com]
Fault phenomenon: ECG scan baseline can not be stabilized on the display, and sometimes drift out of the display area.
Inspection methods: (1) whether the instrument is used in a humid environment and whether the inside of the instrument is damp. (2) Check how the quality of electrode piece and whether the part of human body contacting electrode piece is cleaned.
Solution: (1) Turn on the instrument continuously for 24 hours and drain the moisture by itself. (2) Replace the electrode sheet and clean the part of human body that touches the electrode sheet.
4 ECG waveform disorder
Fault phenomenon: ECG waveform is too large, can not see the whole waveform.?
Check method: Check whether the ECG amplitude in the ECG setting is set too large, so that the ECG waveform overflows.
Solution: Adjust the ECG amplitude to a suitable value, and the whole waveform can be observed.
5 No blood oxygen value or blood oxygen value intermittently
Fault phenomenon: When measuring the human blood oxygen saturation, the blood oxygen value is sometimes absent.
Check method: (1) When doing long-term monitoring and surgery, whether the patient’s arm is moving around, causing intermittent oxygen values. (2) Check whether the blood oxygen extension line is bad.
Solution: Keep the patient as stable as possible. Once the oxygen value is lost due to hand movement, it can be considered normal. If the oxygen extension cord is bad, replace it with a new one.
6 Blood pressure measurement value is not normal
Fault phenomenon: the measured blood pressure value deviation is too large.
Check method: Check whether the blood pressure cuff is leaking, and whether the pipe interface connected with the blood pressure is leaking.
Solution: Replace the cuff with a good cuff or connector.
7 blood pressure insufficiently inflated
Fault phenomenon: when measuring blood pressure inflation pressure is not always filled up (below 150mmHg), can not be measured.
Inspection method: Check whether the blood pressure cuff and its extension tube are broken.
Solution: Replace the cuff with a good quality blood pressure cuff.