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CDHB

Telemetry Guidelines

Placing patients on telemetry is a medical decision. However, as there are only a limited number of telemetry units available, all requests for telemetry should be discussed with Cardiology. Generally, it is inappropriate to have a patient on telemetry whose status is DNACPR (do not attempt CPR).

Mandatory Monitoring

• Patients with a ventricular arrhythmia that is life-threatening:
  • Monitoring should be continued until the arrhythmia is controlled.
• Patients with cardiac instability receiving intravenous infusions that require cardiac monitoring: The list includes adenosine, amiodarone, dobutamine, dopamine, flecainide, phenytoin, beta-blockers, and verapamil. See CDHB guidelines for IV Administration of Drugs that require Cardiac Monitoring (search for "cardiac monitoring" at http://cdhb.health.nz).
  • Monitoring should continue for up to six hours post drug administration.
• Patients with symptomatic bradycardia or documented heart block:
  • Monitoring must continue while patient remains symptomatic and/or in heart block.
• Patients with temporary pacemakers (usually nursed in CCU, but not compulsory):
  • Monitoring must continue while a temporary pacemaker is in situ.
• Malfunctioning pacemaker/Automatic Implantable Cardioverter Defibrillator (AICD):
  • Monitoring must continue until satisfactory pacing check/appropriate corrective action taken.
• Post permanent pacemaker/AICD insertion:
  • Monitor overnight or until pacing check done.
• Patients post cardiac radiofrequency ablation:
  • Monitor overnight.
• Patients post myocardial infarction (ECG changes evident or with positive troponin results):
  • Monitor for 48 hours. May require longer if documented adverse arrhythmia.
• Patients suspected of having an Acute Myocardial Infarction:
  • Monitor until diagnosis is excluded.
  • Monitor for 48 hours if diagnosis confirmed.

Discretionary Monitoring (discuss with Cardiology Registrar on call)

• Patients post PTCA (or as ordered by the Interventionist Cardiologist):
  • Monitor for 12 hours.
• Syncope, if a cardiac arrhythmia is suspected:
  • Monitor for 24 hours. Remove after 24 hours if no evidence of arrhythmia.
• Atrial fibrillation/atrial flutter if:
  • Poor ventricular rate control (rapid ventricular response).
  • Concern that the rhythm may be associated with syncope or underlying ACS.

    Note: Elderly patients with a ventricular rate of less than 150/min may be able to be observed on AMAU using a bedside monitor.

  • Monitor during treatment, e.g., electrical or chemical cardioversion.
  • Monitoring can be discontinued once the patient has been in sinus rhythm for one hour post cardioversion.
• Drug overdoses at risk of cardiac arrhythmia:
  • Patients who have taken tricyclic antidepressants and who have syncope, seizures, or an abnormal ECG on presentation.
  • Monitor for 24 hours.
  • Monitor asymptomatic patients until the QRS is less than 100 milliseconds.
• Potassium and/or magnesium electrolyte abnormalities:
  • Potassium level of less than 2.5 mmol/L.
  • Potassium level of greater than 6 mmol/L.
  • Magnesium level of less than 0.6 mmol/L.
  • Monitor for at least 6 hours after normalization of serum potassium.
  • If no arrhythmias have occurred, patients can be observed on AMAU using a bedside monitor.
• Patients without cardiac instability receiving intravenous infusions that require cardiac monitoring: The list includes adenosine, amiodarone, dobutamine, dopamine, flecainide, phenytoin, beta-blockers, and verapamil. See CDHB guidelines for IV Administration of Drugs that require Cardiac Monitoring (search for "cardiac monitoring" at http://cdhb.health.nz).
  • Monitor for at least 6 hours post drug administration.
  • These patients can be observed on AMAU using a bedside monitor.

Topic Code: 3867