Telemetry

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