What is Telemetry and Telemetry Lead Placement?

Telemetry nursing is a very specific and advanced field of nursing. Learn all about what telemetry is, telemetry lead placement, and what telemetry nurses do. 

What is Telemetry?

Have you heard the term “telemetry” before? If you have but aren’t sure what it means, you aren’t alone! The term ‘telemetry’ comes from the Greek roots tele meaning “remote”, and metron meaning “measure”. 

Telemetry is used in different fields and in many different ways (examples: missiles, chemical plants, spacecraft). A common example of telemetry in the medical setting would be a cardiac monitor.

The telemetry medical definition is monitoring a patient’s vital signs and transmitting that data by to a central location where healthcare providers can review it and watch for any sudden changes to a patient’s condition.

What is a Hospital Telemetry Unit?

The telemetry unit of a hospital is where patients go when they need continuous telemetry monitoring. Cardiac nurses (also called Telemetry nurses) work in the Telemetry unit because they have the training and experience necessary to help patients needing complex care. 

In a hospital, telemetry provides nurses and other healthcare professionals the ability to monitor the patient’s heart rhythms and rate remotely. Patients who have experienced certain cardiovascular events need to be closely observed by nurses through continuous telemetry.

This is usually accomplished with a portable device that continuously monitors the 5-lead ECG tracing and heart rate of a patient and transmits that information to a central monitor. Med surg telemetry nurses and other healthcare providers review the data to try to determine whether negative changes to the current heart function are likely to occur.

Telemetry monitoring may last from 24 hours to 72 hours or more, depending on the patient’s condition. For some, they may require continuous telemetry monitoring during their entire admission.

Patient situations that often require telemetry monitoring

There are several common diagnoses that lead to patients needing monitoring with telemetry.

Here’s are a few:

1. Chest pain. Of course when anyone hears “chest pain” they think “heart attack”, so we treat incoming patients complaining of chest pain as possibly having a myocardial infarction (heart attack) and immediately hook them up to telemetry to monitor their heart rate and rhythm to help determine whether they are having a heart attack. They likely will also get a 12-lead ECG in addition to being hooked up to the continuous 5-lead ECG monitoring.
2. Atrial Fibrillation (A-fib). This is an abnormal heart rhythm where the heart is out of a synchronous pattern so the blood doesn’t move as it should, raising the risk of developing a clot. The higher the heart rate, the more dangerous it is.
3. Congestive Heart Failure (CHF). Although this diagnosis is more chronic in nature than the others I just mentioned, telemetry nurses monitor patients with CHF to make sure they aren’t heading into a situation that needs more immediate or extensive care. However, some patients will come into the hospital with a CHF exacerbation, who are at a higher risk for developing abnormal heart rhythms.
4. Electrolytes imbalance. When electrolytes, specifically potassium and magnesium, are too high or too low, they can cause dysrhythmias which need to be monitored through telemetry while the cause and prescribed care are determined.

Other potential diagnoses that can be monitored include in a hospital telemetry unit include COPD, recovery from heart surgery, bradycardia, tachycardia, ectopic beats, and other cardiovascular abnormalities.

Getting Accurate Readings

Accurate telemetry readings are crucial to providing correct and necessary care to patients.

Telemetry monitoring only provides accurate information with properly maintained equipment, good skin preparation, lead placement, and patient monitoring.

Telemetry Lead Placement

Here’s a very generalized process for proper set up of a telemetry heart monitor. 

Prepare the Skin

Telemetry nurse cleans the skin with soap and water if visibly dirty, and then removes any excess oil with an alcohol swab to prepare it. Once the skin is fully dry, then the sticky patches can be placed.

If you’ve got a patient with a very hairy chest, you’re not going to get a good tracing unfortunately. The sticky leads have trouble adhering to the skin. You likely will need to get a safety razor and shave the spots that you’ll place the leads.

How to Put Leads on a Patient

Tele lead placement involves placing between 3 and 12 electrodes on the chest, stomach, legs, and arms. Correct placement is essential because incorrect electrode placement can lead to misdiagnosis or improper tracing.

Each sticky pad (electrode) is attached to a wire which is then attached to a small device that transmits data about the heart’s electrical activity to the centralized monitoring station. As the nurse, you’ll first apply the stick pad to the correct spots and then attach the lead with the wire to that pad.

Here are the correct heart monitor lead placement locations for a 5-lead cardiac monitor:

1. Under the right clavicle, near the right shoulder
2. Under the left clavicle, near the left shoulder
3. Left upper quadrant of the abdomen, just below the rib cage
4. Right upper quadrant of the abdomen, just below the rib cage
5. Between the Xiphoid process and the right upper quadrant electrode

Set Up the Unit

Medical Surgical Telemetry Nurses ensure the cardiac monitor is set up correctly following this process:

1. Check that the telemetry monitor has battery power – you may need to put in fresh batteries
2. Attach the sticky electrodes to the patient
3. Attach the wires from the telemetry leads to the telemetry unit
4. Go to the central monitoring station check that the readings on the bedside monitor or nursing unit monitor are clear
5. Verify that you’ve got the correct patient, name, MRN, and room number with the right telemetry box number
6. Ensure settings on the monitor are correct. If your telemetry unit has people monitoring the screens in a different setting (a remote location), you won’t be able to adjust the settings yourself. You’ll have to call the telemetry department to do so.

For example, if the patient has a pacemaker, there is a specific setting that must be selected for it to read correctly.

Telemetry Nurse Duties

Telemetry nurses work with patients who have cardiac problems or are recovering from cardiac procedures. They generally work in the telemetry unit of the hospital after leaving the ICU or cardiac units.

Telemetry vs Med Surg

While telemetry nursing and med surg nursing overlap some, med surg nurses care for patients who are being prepped for or recovering from surgery. In caring for their patients, med surg nurses may have some patients on telemetry… but also may have quite a few who are not.

A telemetry nurse, however, will likely have all of their patients on telemetry.

Side note: All patients in stepdown/intermediate and intensive care settings WILL have telemetry.

Using the advanced technology requires additional training that set telemetry nurses apart from other fields of nursing.

Cardiac monitoring is a technical area of nursing that requires the use of advanced and complex equipment to help monitor and care for patients that have experienced a variety of cardiac problems.

More Resources for Cardiac Nurses:

• Tips for Cardiac Nurse Assessment
• Cardiac Nursing For Beginners
• Cardiac Nurse – A Typical Day