Welch Allyn Arrhythmia Monitoring Chart Quick Reference Guide

P-R
Interval
QRS Duration
P
S
T
R
Q
Q-T
Interval
Arrhythmia Monitoring
on the Welch Allyn Acuity® Central Station
Using Mortara Instrument’s VERITAS™ ECG analysis algorithms
QRS NORMAL SINUS RHYTHM EXAMPLE
Arrhythmia Alarms Setup Window
ARRHYTHMIA EVENT DEFINITIONS
ARRHYTHMIA EVENT
VFib 1
(Ventricular
Fibrillation)
Lethal Arrhythmia
Asystole
Lethal Arrhythmia
VTach 2
(Ventricular
Tachycardia)
Lethal Arrhythmia
WAVEFORM EXAMPLES DEFINITION
Chaotic quivering of the ventricles accompanied by rapid irregular waves but no formed QRS complexes.
Absence of any detected beat for 4 or more seconds.
Characterized by a run of premature ventricular beats that exceeds the PVC run alarm limit setting and that meets or exceeds the patient’s VTach alarm limit.
a
Irregular Limit:
PVC Run
(Ventricular Run)
VRhythm
(Ventricular
a
b
c
Rhythm)
Couplet Characterized by two consecutive
Characterized by a run of three to six consecutive, premature ventricular beats that meets or exceeds the patient’s VTach alarm limit.
Characterized by a run of successive ventricular beats that is less than the VTach alarm limit setting, and the number of successive ventricular beats is greater than or equal to three.
ventricular beats that are preceded and followed by a normal beat.
Preferences vary regarding Acuity System alarming sensitivity for irregular rhythm arrhythmia types. There is now a way to adjust the minimum time that an irregular rhythm occurs before your Acuity System alarms, on a patient-by-patient basis.
b
Single ECG:
The system uses up to three ECG leads to detect normal beats, ventricular beats and to analyze arrhythmias. If false arrhythmia alarms are occurring due to a patient’s unique beat morphology, you can direct the Acuity System to analyze arrhythmias using one reliable lead.
WARNING If you turn on Single ECG in response to false lethal arrhythmia alarming (for example,
due to bundle branch block or irregular rate), arrhythmia analysis is limited to one lead. Typically, 3-lead analysis (via a 5-lead cable) is optimal.
c
Analyze Pacers:
Always turn on Analyze Pacers for paced patients, and always turn off Analyze Pacers for non­paced patients. The Acuity System analyzes arrhythmias based on whether the Analyze Pacers setting is on or off. The Analyze Pacers setting is Off by default.
PVC/min
(Ventricular
Beats per
Minute)
Bigeminy
Trigeminy
Premature ventricular contractions (PVCs, either unifocal or multifocal) that are greater or equal to the patient’s PVC/min alarm limit setting.
Characterized by three or more successive cycles consisting of a normal beat followed by a premature ventricular beat. Bigeminy is independent of the average heart rate.
Characterized by three or more successive cycles of two normal beats followed by a premature ventricular beat. Trigeminy is independent of the average heart rate.
ECG Lead Selection and Placement
If monitoring with Propaq® LTR or Micropaq®, Acuity will use ECG leads II, V and III for arrhythmia analysis.
®
If monitoring with Propaq for ECG1 and/or ECG2. To optimize arrhythmia analysis performance: verify that the ECG lead(s) have significant amplitude. Otherwise, an incorrect heart rate or arrhythmia alarm condition could occur.
If the QRS complex is less than twice the amplitude (height) of the P and T waves, a different monitoring lead should be selected. Tall P and T waves may be incorrectly classified as a QRS complex or PVC and potentially generate a high heart rate or other alarm condition.
CS and/or Propaq Encore®, Acuity uses the leads that the user selects
Tachycardia
Bradycardia
Irregular
(Irregular
Rhythm)
Characterized by a HR greater than or equal to the patient’s tachycardia alarm limit value. (If the tachycardia limit is decreased past the HR high limit, then the HR high limit will decrease to a value equal to the tachycardia limit.)
Characterized by a HR less than or equal to the patient’s bradycardia alarm limit value. (If the bradycardia limit is increased past the HR low limit, then the HR low limit will increase to a value equal to the bradycardia limit.)
An irregularity in the R-to-R interval over a series of at least 16 nonventricular beats.
The Relearn Function
The Relearn function enables the clinician to tell Acuity to relearn a patient’s rhythm based on the patient’s dominant beat morphology.
During the learning period, Acuity indicates only the VFib and Asystole arrhythmia conditions. Other vital signs are unaffected.
Acuity automatically relearns the patient’s normal reference beats whenever the alert presents itself under the following conditions:
 • Afterpatientconnectionorsystemrestart  • Aftersomeleadchangesorleadfailures  • AfterST/Arr Relearn or Analyze Pacers or Single ECG is clicked in the Arrhythmia
Alarms Setup window
WARNING Inappropriate use of Relearn can lead to mislabeling of beats and possibly a
failure to alarm. Carefully evaluate the patient’s current rhythm to make sure that you want the Acuity System to establish it as the patient’s normal sinus rhythm.
Pause
Noncapture
(Pacemaker
Noncapture)
An R-to-R interval that is greater than or equal to two times the average R-to-R.
For pacemaker patients with the Analyze Pacers option enabled, a beat does not directly follow a pacer.
1. VFib is detected if the waveform fulfills the following conditions for at least 5 seconds:
Absence of fast slew-rate activity (QRS-like activity). Average peak-to-peak wave amplitude higher than 200 µV.
Wave rate higher than 130 bpm. Wave period variance higher than a specific threshold.
2. The American Heart Association describes sustained and nonsustained ventricular tachycardia as follows: Ventricular tachycardia can be referred to as sustained or nonsustained. Sustained refers to an episode that lasts at least 30 seconds and generally requires termination by antiarrhythmia drugs, antitachycardia pacing techniques or electrical cardioversion. Nonsustained ventricular tachycardia suggests that the episodes are short (three beats or longer) and terminate spontaneously.
The average heart rate is calculated on the basis of the mean R-to-R interval of the last 16 beats. If the heart rate calculated using the last four beats is less than or equal to 48, then this rate is used.
©2009 Welch Allyn, Inc. All rights reserved. Acuity, Micropaq, Propaq and Propaq Encore are all registered trademarks of Welch Allyn, Inc. Other company names mentioned herein are for identification purposes only and may be the trademarks or registered trademarks of their respective companies.
Printed in USA SM2567 Rev C
Loading...