Using a special recorder–transmitter, patients at home can transmit ECGs by telephone to a central monitoring center for immediate interpretation. This technique, called transtelephonic cardiac monitoring (TTM), reduces healthcare costs and is widely used. Nurses play an important role in TTM. Besides performing extensive patient and family teaching, they also run the central monitoring center and help interpret ECGs sent by patients. TTM allows the practitioner to assess transient conditions that cause such symptoms as palpitations, dizziness, syncope, confusion, paroxysmal dyspnea, and chest pain. Such conditions commonly aren’t apparent while the patient is in the presence of a practitioner, which can make diagnosis difficult and costly. With TTM, the patient can transmit an ECG recording from their home when symptoms appear, avoiding the need to go to the hospital for diagnosis and offering a greater opportunity for early diagnosis. Even if symptoms don’t appear often, the patient can keep the equipment for long periods of time, which further aids in the diagnosis of the patient’s condition. Home care TTM can also be used by patients who have cardiac rehabilitation at home. The patient is called regularly during this period to receive transmissions and assess progress. This monitoring can help reduce the anxiety felt by many patients and their families after discharge, especially if the patient suffered a MI. TTM is especially valuable for assessing the effects of drugs and for diagnosing and managing paroxysmal arrhythmias. In both cases, TTM can eliminate the need for admitting the patient for evaluation and a potentially lengthy hospital stay. Understand ing TTM equipment TTM requires three main pieces of equipment: an ECG recorder–transmitter, a stand ard telephone line, and a receiver. The ECG recorder–transmitter converts electrical activity picked up from the patient’s heart into acoustic waves. Some models contain built-in memory that stores a recording of the activity so the patient can transmit it later. A stand ard telephone line is used to transmit information. The receiver converts the acoustic waves transmitted over the telephone line into ECG activity, which is then recorded on ECG paper for interpretation and documentation in the patient’s chart. The recorder–transmitter uses an electrode applied to the finger, chest, or a wrist bracelet. These electrodes produce ECG tracings similar to those of a stand ard 12-lead ECG. Credit card–size recorder One type of recorder operates on a battery and is about the size of a credit card. When a patient becomes symptomatic, they hold the back of the card firmly to the center of their chest and push the start button. Four electrodes located on the back of the card sense electrical activity and record it. The card can store 30 seconds of activity and can later transmit the recording across phone lines for evaluation by a practitioner. Other transtelephonic monitors are approximately the size of a beeper and store lengths of ECGs on a digital chip, which can then be transmitted over the phone line and recorded on paper. |