Accuracy of bedside electrocardiographic monitoring: a report on current practices of critical care nurses

Diagnostic criteria for many arrhythmias can be observed from any monitoring lead; however, other important criteria are "lead specific," such as the diagnostic QRS patterns in V1 that aid in distinguishing ventricular tachycardia from supraventricular tachycardia with bundle branch block or aberration. Therefore, it makes a great deal of difference which leads are selected for bedside monitoring. Our purpose was to determine which leads nurses select for monitoring, and the accuracy of lead placement. From a random sample of nurses who were members of the American Association of Critical-Care Nurses, 302 returned a monitoring questionnaire. Average critical care experience was 8.5 years. Lead II was most often selected (74%) for single-channel monitoring; lead II plus V1 (or MCL1) were most often selected (87%) for dual-channel monitoring. Only 37% of nurses demonstrated proper technique for obtaining their single lead of choice; even fewer (13%) demonstrated proper technique for obtaining their dual leads of choice. These results suggest that misdiagnosis of arrhythmias such a wide complex tachycardia in monitored patients may be caused by inappropriate lead selection as well as inaccurate lead placement.