Congress Abstracts 2005

87

THE IMPLEMENTATION OF TELEMETRY MONITORING ON A THORACIC UNIT. Wendi Stone, BSN, and Maureen Jingeleski, BSN, Memorial Sloan-Kettering Cancer Center, New York, NY.

Postoperative thoracic oncology patients are at risk for developing cardiac arrhythmias, specifically atrial fibrillation (AF). Patients with post-operative AF are often asymptomatic therefore new onset AF could go undetected. This NCI designated cancer center implemented a telemetry monitoring system on the thoracic medical and surgical unit to be able to detect AF on initial onset and thus improved patient care by initiating care early.

Atrial Fibrillation is a complication of lung cancer surgery in 10%–40% of patients. Arrhythmias are associated with increased postoperative morbidity and mortality. Potential causes are related to surgical proximity, hypovolemia, hypoxia, electrolyte imbalances, and other co-morbidities. Telemetry allows for early identification of arrhythmias. Early cardiac intervention allows the patient to get out of AF before they become at significant risk for thrombolitic complications due to the arrhythmia or to begin antithrombolitic therapy as soon as clinically indicated.

The telemetry program was initiated in 2002 with 8 wireless monitors and pagers. The nursing staff were deemed competent after successful completion of an eight hour dsyrhythmia class and post-test. The institution then developed a plan of care for post-op thoracic patients needing telemetry. The patients who meet certain criteria are placed on telemetry for 48 hours. If no arrhythmia is detected the telemetry is discontinued, if an arrhythmia is detected the patient remains on monitoring and requires additional medical interventions. The nurse is responsible for printing a daily rhythm, performing a cardiovascular assessment, monitoring lab values, and vital signs. Treatment for AF includes the administration of IV diltiazem, supplemental oxygen, and replacement of electrolytes.

Undetected arrhythmias result in complications such as pulmonary embolism and respiratory distress, requiring transfer to the ICU, and prolonged hospital stay. Telemetry monitoring have resulted in shorter length of stay, fewer postoperative complications, and a decrease in hospital costs.

The telemetry monitoring allows for early identification and treatment of arrhythmias. Due to the improved patient outcomes with the telemetry program four more telemetry monitors are to be added in the fall of 2004 and four more in 2005.