Cardiac Monitoring and Electrode Placement Revisited

Continuous cardiac monitoring has been used in hospital units for more than 50 years, starting in early cardiac care and heart surgery units and expanding to intermediate care.^1,2  With more than 5000 hospitals using cardiac monitors in the United States, it is peculiar that we do not know much about how cardiac monitoring is actually practiced in the field. Several surveys or audits have been published,^3–5  but only 1 recent large-scale study, the Practical Use of the Latest Standards for Electrocardiography (PULSE),⁶  examined the way we use cardiac monitoring.

One purpose of the PULSE study was to evaluate nurses’ knowledge of accurate cardiac monitoring practices on the basis of the 2004 standards for cardiac monitoring in hospitalized patients.⁷  Those standards made specific recommendations for both optimal populations that benefit from cardiac monitoring (Table 1) and the 4 domains of continuous...