TelemETRY

Currently cardiac telemetry monitoring (arrhythmia, ST-segment & QTc) is limited to the MICU, PCU, and 4C medicine wards. Due to this limitation there may be delays in patients being admitted to telemetry from the emergency department or unnecessary boarding within the MICU awaiting a telemetry bed.

Please review the the evidence based indications for telemetry monitoring within our facility. These guidelines are taken from the AHA Guidelines (2017) and the summative VHA telemetry Guidebook (2020)

Telemetry should be reviewed on a daily basis, and discontinued if no longer indicated or appropriate.

To Remove Telemetry

1) Change ADT order (From Telemetry to Medicine)

2) Put in Nursing text order (Order #99) (Please discontinue telemetry)

Class 1 (Recommended; beneficial)

Acute Coronary Syndrome
CVA (suspected or confirmed)
Acute CHF exacerbation
New AFib or AFlutter requiring initiation of new anti-arrhythmic
Symptomatic Bradycardia
2nd/3rd degree AV Block
Cardiogenic Syncope
Severe electrolyte derangements (K+ or Mg+)
Post-MI with revascularization
Vasospastic Angina (Prinzmetal)
Drug overdose with potential cardiac toxicity
Post V.Tach/V.Fib or ICD shock requiring admission

Class 2 (Reasonable; may be of benefit)

ACS Rule out
Complicated alcohol withdrwal
Acute medical condition causing symptomatic ventricular
Non sustained V.Tach
Infective Endocarditis (until clinically stable)
Post-conscious sedation
Post-major thoracic surgery
Post complicated PCI

Class 3 (Not Recommended, no benefit, may be harmful)

Chest pain at low risk for ACS (negative biomarkers and normal EKG)
Post routine coronary angiopgraphy with non-urgent uncomplicated PCI
Chronic Atrial fibrillation, rate controlled
Asympomatic sinus bradycardia
Ventriculary paced rhythm
Uncomplicated alcohol withdrawal
Post-noncardiac surgery

Critical Care

Patients in ICU
Targeted temperature management
Post EP/Cardiac Surgery