2.1 Common Problems in Cardiac Monitoring Cardiac monitoring produces a continuous waveform of a patient's cardiac electrical activity to accurately assess the patient's physiological state at that time.
2.1.1 Cause of alarm indicating lead detachment (1) Electrode detachment; (2) leadwire and electrode connection detachment; (3) trunk and leadwire detachment, and trunk and mainframe port detachment; and (4) breakage of guidewire within the leadwire.
2.1.2 Reasons for ECG baseline wandering (1) If intermittent wandering: inaccurate placement of electrodes; poor connection of electrodes, wires, and wires. (2) If continuous wandering: often caused by respiratory effort.
2.1.3 Reasons for artificial interference in the ECG The patient's muscle fibrillation (chills, nervousness, etc. can easily cause muscle fibrillation, and the wave shape is similar to atrial fibrillation wave), baseline wandering.
2.1.4 Reasons for false alarms (1) Due to inappropriate adjustment of the upper and lower limits of each parameter. Frequent alarms can occur when the upper limit is set too low and the lower limit is set too high. (2) In the acute stage of myocardial infarction and patients with high blood potassium, the false alarm of heart rate is twice as high because the sensing line senses R wave and T wave at the same time. (3) False alarms for irregular rhythm due to external interference or muscle tremor. (4) In patients with pacemakers, the pacing heart rate is twice as high because the sensing wire senses both the pacing signal and the R wave at the same time. (5) Electrode sheet allergy, due to artificial stimulation, around the electrode sheet, the screen appears similar to ventricular fibrillation and false alarm [1].
2.2 Common Problems in Heart Rate Monitoring Heart rate is the number of beats per minute of the heart, which can be obtained by ECG (electrocardiogram) or PLETH (pulse oximetry wave) on the monitor. (1) There is an ECG that does not show a heart rate. Select the source of heart rate is PLETH without heart rate, may be the oxygen probe is not connected or damaged, should check the oxygen probe. Selecting the source of heart rate is ECG without heart rate, it may be caused by the ECG signal is too high or too low, difficult to observe, unable to display the correct heart rate, etc., with the former being the most common. (2) Clinical heart rate is common in the heart rate alarm range of ECG monitoring and alarm more than, at this time, should pay attention to the source of the heart rate is ECG or PLETH, targeted adjustment of the heart rate alarm boundaries.
2.3 Common problems in respiratory monitoring The monitor commonly used impedance measurement method to measure respiration, that is, according to the 2 electrodes of the thoracic impedance changes in the determination of respiration, producing respiratory waves on the screen. (1) Abnormal respiratory parameters or "-? - -" is displayed. It may be that the electrodes are not properly placed, the electrodes are falling off, etc. (2) False alarm cause: high and low limit alarm value is not set properly.
2.4 Common Problems in Oxygen Saturation Monitoring Oxygen saturation, or SpO2, is defined as the percentage value of oxygenated hemoglobin to hemoglobin. The commonly used arterial oxygen quantification technique, which measures how much light emitted from one side of the sensor's light source travels through the patient's tissue to the other side of the receiver, is a non-invasive method of determining oxygen saturation. Changes in oxygen saturation readings are the most timely and rapid warning to report that a patient is hypoxic.
2.4.1 Signal Tracks to Pulse, No Oxygen Saturation and Pulse Rate Values on Screen Cause: (1) Patient is overly mobile and too agitated for the oximetry parameter to find a form of pulse; (2) Patient's perfusion may be too low, such as low limb temperatures and poor peripheral circulation, so that the oxygenation parameter is unable to measure the oximetry and pulse rate, (3) Damaged sensors; (4) Sensor Inaccurate position of the sensor (the connector line should be placed on the back of the hand, fingernail side up); (5) blood staining agents (such as methylene blue, fluorescein), skin coloring, or fingernails coated with nail polish, will also affect the accuracy of the measurements; (6) the environment has a strong light source. Such as surgical lamps, fluorescent lamps or other direct light, will make the probe's photosensitive element acceptance value deviates from the normal range, so need to avoid strong light. If necessary, the probe needs to be used to block the light; (7) after the probe is worn for too long, it may affect the blood circulation, so that the measurement accuracy is affected; (8) in addition, the same side of the arm to measure blood pressure, it will affect the peripheral circulation and make the measurement value has an error.
2.4.2 Rapid changes in oxygen saturation, signal strength wandering Possibly due to excessive patient movement or due to surgical devices to interfere with operational performance.
2.4.3 Oxygen saturation display sensor off (1) sensor in place and good performance, should pay attention to whether the connection is normal, the most common clinical situation that the liquid splashed into the sensor connector; (2) oxygen probe work normally, after the boot self-test, the probe sends out a darker red light or a brighter red light and flicker.
2.5 Common Problems in Noninvasive Blood Pressure Monitoring Blood pressure often refers to the pressure of the blood flow in the blood vessels on the vessel wall, the monitor is commonly used to measure the oscillation method. The cuff is inflated first to block arterial blood flow, and then the cuff is deflated from a point higher than the systolic pressure. During deflation, the arterial blood flow oscillates and is superimposed on the pressure in the bag, and the pressure change in the cuff is measured by the instrument, so the entire line must be free of leaks in order to maintain normal operation of the blood pressure measurement.
2.5.1 Factors affecting non-invasive blood pressure measurement (1) the patient's body position, the measured limb and the patient's heart should be at the same level, especially when sleeping on the side should pay attention to the measured limb above the body, below the body have an impact on the results of the blood pressure measurements; (2) the use of different cuffs for cardiac monitors to make the blood pressure measurement value of the bias; (3) the limbs of large activities, the frequency of the high frequency of the patient should be kept quiet; (4) cuff leakage, the cuff should be kept quiet; (4) the cuff leakage, the patient should be kept quiet. quiet; (4) cuff leakage, leakage of the pipe joints connected to the cuff; cuff too loose, pipe knotting, jamming; (5) the patient's condition is changing greatly, such as shock blood pressure drops sharply, etc.; (6) the use of ventilator. The parameters of the ventilator should be adjusted appropriately; (7) the selected cuff is too large or too small, and the cuff is bundled in an incorrect position are the main reasons for inaccurate measurements. In addition, when the weather is cold, the patient wears more clothes, if the sleeves are not removed, but rolled up, then not only the cuff can not be placed in place, the blood supply of the artery to be measured will also be affected.
2.5.2 Pump inflation without blood pressure Check the mode used by the monitor, whether it is adult mode or child mode. If adults use the children's mode, only to hear the sound of the pump pumping can not measure the blood pressure; if children use the adult mode, too high pressure cuff inflation, causing harm to the child. Should be adjusted accordingly.
3 Nursing countermeasures
3.1 Treatment of common problems in cardiac monitoring
3.1.1 Treatment when the alarm shows that the lead is off (1) Replacement of the electrodes, and strive to do a good job of cleaning the skin at the site of the electrode placement, because the skin is a bad conductor, so it is necessary to obtain good contact between the electrode and the skin. If necessary, first use alcohol to remove grease sweat on the skin. (2) Stress ring stability. Stress loop: the lead wire is wound into a loop at 6.6 cm from the electrode/lead wire connection, and the stress loop is taped to the patient, which relieves the pull of the lead wire on the electrode and prevents the lead wire from rotating in order to minimize many human failures. (3) Check whether the connections are well connected. Ask a professional to repair it if necessary.
3.1.2 Handling when the ECG baseline wanders The patient's condition must be closely observed, the cause must be found and appropriate treatment must be made in a timely manner, and the stress ring should be stabilized if necessary.
3.1.3 Handling of ECG artificial interference Try to relieve the patient's physical discomfort, keep the environment quiet and comfortable, if necessary, follow the doctor's orders to give sedatives, so that the patient is in a quiet state.
3.1.4 Treatment of false alarms (1) closely observe the condition; (2) according to the patient's condition to adjust the alarm value of the high and low limits. Heart rate alarm value setting: If the upper and lower limits for sinus rhythm is generally plus or minus 20% of the patient; such as supraventricular tachycardia, ventricular tachycardia patients, according to the number of episodes of heart rate to set the upper limit of the heart rate, set up by the machine >120 times/min to >150 times/min; atrioventricular conduction block, sinus syndrome patients, according to hemodynamic changes in the lower limit of the adjustment of 35 ~ 50 times/min; atrial block, sick sinus syndrome patients, according to hemodynamic changes in the lower limit of the adjustment of 35 ~ 50 times/min; atrial block, atrial block, atrial block, sick sinus syndrome patients, according to hemodynamics change. 50 times / min; atrial fibrillation patients upper limit adjusted to 100 times / min, and irregular heart rate, rhythm alarm off, so as not to cause false alarms and invalid alarm [2].
3.2 Handling of common problems in heart rate monitoring First, check whether the source of heart rate is PLETH or ECG, then check the source of the failure, and then deal with the corresponding problems; regarding the adjustment of the heart rate alarm limit, the upper and lower limits of the measurement value should be adjusted in advance according to the patient's condition, to avoid omission of alarms and invalid alarms.
3.3 Handling of common problems in respiratory monitoring
3.3.1 Abnormal respiratory parameters or "-? - -" display should check whether the electrodes are properly placed and whether they are detached. No additional electrodes are needed to monitor respiration, but the placement of electrodes is important. 2 electrodes used to extract respiratory signals can be placed diagonally to obtain the best respiratory wave. Some patients due to the condition of the weak signal, shallow breathing, inaccurate counting, it is best to place the two respiratory electrodes in the right axillary midline medial and thoracic left side of the respiratory activity of the largest area to obtain the best respiratory wave, but to avoid ventricular and hepatic areas in the respiratory electrode line, in order to avoid generating pseudo-differentials. At the same time, the patient's condition should be closely observed, with or without asphyxia, hypoxia, respiratory irregularities, etc., and timely measures should be taken to relieve the patient's respiratory distress symptoms [3].
3.3.2 Improper setting of high and low limit alarm values The respiratory parameters are in the normal range but the respiratory alarm should be reset. Respiratory alarm value setting: general low limit is 8-10 times/min; high limit is 35 times/min.
3.4 Common problems in oxygen saturation monitoring
3.4.1 Signal tracking to the pulse, no oxygen saturation and pulse rate on the screen when the treatment (1) closely observe the patient's condition; (2) make the patient remain motionless or move the sensor to a less active limb, so that the sensor is firm and appropriate. Limbs, so that the sensor is firm and appropriate or healthy people to test, if necessary, replace the sensor; (3) if necessary, the measured patient to pay attention to warmth; (4) the need to avoid bright light; (5) too long can be replaced with another finger measurement; (6) try to avoid the same side of the arm to measure blood pressure.
3.4.2 Handling of rapid changes in oxygen saturation, signal strength wandering Try to keep the patient quiet and less mobile, away from the surgical device.
3.4.3 Handling when the oxygen saturation display sensor falls off (1) If the liquid splashes into the sensor connector, use a dry cloth to clean it, wait for a period of time after drying or blow drying to return to normal operation; (2) When the oxygen probe works normally, and the probe sends out a darker red light or a brighter red light after the power on self-test and flickers erratically. At this time to replace the cable.
3.4.4 SpO2 alarm value setting SpO2 normal value, SpO2 measured value ≥ 95% ~ 97% when inhaling air. Hypoxemia: SpO2 <95% for deoxygenation, SpO2 <90% for mild hypoxemia, SpO2 <85% for severe hypoxemia. In general, the low alarm limit should be set higher than 90%.
3.5 Treatment of common problems in noninvasive blood pressure monitoring
3.5.1 Selecting the correct mode Carefully check whether the cuff line connection is leaking, replace the good cuff or connector, it is recommended that the cuff should be at the same level with the heart; choose the right size of the cuff; make the patient take a lying position and keep quiet when measuring blood pressure. Observe the condition closely and deal with any abnormalities promptly. The correct way to measure blood pressure: the patient's artery and the cuff labeled (artery) arrow aligned, the cuff around the appropriate elasticity, can be inserted into a finger, position change, blood pressure is too low, the patient is asked to lie down in the position of the re-measurement or re-measurement of the sphygmomanometer.
3.5.2 Setting of blood pressure alarm values Normal diastolic blood pressure is 60 to 90 mm Hg, systolic blood pressure is 90 to 140 mm Hg. The range of alarm values can be adjusted appropriately according to the patient's medical history and condition.
3.6 Psychological care Do a good job of communication, provide a comfortable environment to obtain the cooperation of the patient to ensure the quality of monitoring: (1) do a good job of communicating with patients and their families before use, explaining the importance and necessity of it, due to the lack of a correct understanding of the patient's own disease, the application of the monitoring facilities to produce fear, which causes emotional tension and anxiety, aggravating the condition. Fear should be eliminated. (2) The alarm volume should be adjusted appropriately and the alarm sound should be eliminated in a timely manner to prevent the noise generated by the alarm volume being too high and lasting too long from causing the patient to have an irritable mind. Thus ensure that the use of avoid pulling, fall off or even have the phenomenon of self-shutdown. (3) Avoid ward crowding, reduce the movement of medical staff and family members, reduce the visual interference of the flashing lights on the monitor display.