Gima CMS8000 Manual Del Uso página 172

Recommended ECG Lead Placement for Surgical Patients
The placing of the ECG leads will depend on the type of surgery that is being performed. For example, with
open chest surgery the electrodes may be placed laterally on the chest or on the back. In the operating
room, artifacts can sometimes affect the ECG waveform due to the use of ES (Electrosurgery) equipment. To
help reduce this you can place the electrodes on the right and left shoulders, the right and left sides near the
stomach, and the chest lead on the left side at mid-chest. Avoid placing the electrodes on the upper arms,
otherwise the ECG waveform will be too small.
Warning
• When using Electrosurgery equipment, leads should be placed in a position in equal distance from
Electrosurgery electrotome and the grounding plate to avoid cautery. Electrosurgery equipment wire
and ECG cable must not be tangled up.
• ECG cables can be damaged when connected to a patient during defibrillation. Check cables for
functionality before using them again.
• Pacemaker failure: During complete heart block or pacemaker failure to pace/capture, tall P-waves (greater
than 1/5 of the average R-wave height) may be erroneously counted by the monitor, resulting in missed
detection of cardiac arrest.
• External pacing electrodes: When a pacemaker with external pacing electrodes is being used on a patient,
arrhythmia monitoring is severely compromised due to the high energy level in the pacer pulse.This may
result in the arrhythmia algorithm's failure to detect pacemaker non-capture or asystole.
• During surgery: Use the special electrode ECG safety cable, for measuring ECG in the operating room.
These cables have extra circuitry to protect the patient from burn and decrease electrical interference.
This also reduces the hazard of burn in case of a defective neutral electrode at the HF device. These
cables cannot be used for measuring respiration.
• When using Electrosurgery equipment, never place an electrode near the grounding plate of the
Electrosurgery device, otherwise there will be a great deal of interference with the ECG signal.
• Using 5-lead ECG set
The default setting is ECG CH1 corresponding to Channel II, and ECG CH2 to Channel I, you can modify
the setting to meet your needs. You can set them to correspond to any two from I, II, III, aVR, aVL, aVF.,
V. If you set both to the same value, one of them will be adjusted to another option automatically.
(Figure 11-3)
Figure 11-3 ECG Lead
Note
• If a ECG waveform is not accurate, while the electrodes are tightly attached, try to change the lead.
• Interference from a non-grounded instrument near the patient and ESU interference can cause inaccuracy
of the waveform.
Normal QRS complex should be:
• Tall and narrow with no notches.
• With tall R-wave completely above or below the baseline.
• With pacer spike no higher than R-wave height.
• With T-wave less than one-third of the R-wave height.
• With P-wave much smaller than the T-wave.
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