Background
- ~43% of monitored pts do not have a true indication
- Leads to alarm fatigue, unnecessary workups, and is expensive
- Telemetry is not a substitute for more frequent vital signs
- Discuss frequently on rounds: always reassess need and indication
- HDS pts w/o troponin elevation or new arrythmias that admission are typically appropriate for transfer without telemetry
|
Clinical Scenario |
Duration |
|
Cardiac |
|
|
ACS Post-MI |
24-48h 48h after revascularization |
|
Vasospastic angina |
Until symptoms resolve |
|
Any event requiring ICD shocks |
Remainder of hospitalization |
|
New/unstable atrial tachyarrhythmias |
Until stable on medical therapies |
|
Chronic AF w/ recurrence of RVR |
Clinical judgement |
|
Ventricular tachyarrhythmias |
Until definitive therapy |
|
Symptomatic bradycardia |
Until definitive therapy |
|
Decompensated CHF |
Until underlying cause treated |
|
Procedural |
|
|
Ablation (regardless of co-morbidities) |
12-24h after procedure |
|
Cardiac surgery |
48-72h, or until discharge if high risk for decompensation |
|
Non-cardiac major surgery in patient with AF risk factors |
Until discharge from step-down or ICU |
|
Conscious sedation |
Until patient awake, alert, HDS |
|
Miscellaneous |
|
|
Endocarditis |
Until clinically stable |
|
CVA |
24-48h |
|
Electrolyte derangement (K, Mg) |
Until normalization |
|
Hemodialysis |
Clinical judgement |
|
Drug overdose |
Until free of influence of substance |
Notable non-indications:
- PCI for non-ACS indication (i.e. pre-transplant), non-cardiac chest pain, Pt with AICD admitted for non-cardiac cause, non-cardiac surgery, chronic AF and clinically stable
- Contraindicated in hospice/comfort care
- Nearly all noncardiac conditions not in the ICU (i.e., undifferentiated sepsis, stable GI bleed, alcohol withdrawal) upon transfer out of ICU