A holter monitor is a device that records the electrical activity of the heart (ECG) continuously over 24, 48 and 72 hours to monitor for arrhythmias, heart conduction changes or heart blocks. The recording is then received by the clinician and is analysed to determine any further care required. 

The specialist laptop that has been funded by the Guild of Friends has enabled the cardiac physiology team to monitor the holter, and report holter results from socially distanced locations within the Trust, as well as from home. 

The benefit of this is that cardiology staff can be allocated to reporting and will be able to report holters from a more flexible and appropriate environment, rather than a busy office with other competing priorities. This will increase productivity and efficiency of being able to monitor holter monitors and provide the relevant feedback in a timely manner to aid further clinical decisions on a patients care. 

 

 

This equipment is an ECG that is recorded while the child is exercising on a treadmill or an exercise bike. The test assesses how well their heart works when they are active and their heart rhythm during physical exertion. 

This upgraded system is of a higher specification than existing equipment and will enable clinicians to review test data retrospectively and be able to link the machine with a new bike that has been recently purchased and the existing treadmill. This upgrade will enable the BRHC to link the test results electronically to the UHBW Trust IT system and links to the patient administration system, thus providing greater efficiency to the staff team. This will also enable patients to receive feedback on their tests in a timelier fashion. Additionally, the upgraded system will also support the cardiology department’s agenda to increase its audit and quality assurance of the services they provide, through greater visibility and analysis functions. This will provide additional opportunities for research projects that require exercise tolerance testing as part of their data collection 

In today’s complex healthcare environment, the demands on nursing time have never been greater. To care for our population of sicker patients with fewer resources, and to help us make better clinical decisions on the spot, as well as document changes in a patient’s condition at every stage, the Phillips MX450 monitoring system has been vital on Penguin Ward, which is our post-operative surgical ward. 

The monitors pick up the child’s heart rate, the amount of oxygen circulating in their blood (oxygen saturations) and their breathing rate. These observations are constantly monitored, and alarm levels are set so that if they fall below a safe level an alarm is sounded. This alarm alerts the nursing staff to there being a change in clinical status which can help to prevent deterioration of the patient, and prevent emergency situations due to early awareness. 

The installation of the Phillips MX450 monitoring system enables the team to enhance their outcomes and improve clinical performance in a busy ward environment, as well as better supporting patients who are in their care. 

What the monitors show 

 

The TEG machine is a point of care monitoring tool to assess whole blood clotting. TEG assesses the amount of time it takes for a clot to form, the strength of the clot, and stability of the clot. 

Results can appear after 10-20 minutes in both number form and also as a graph. The results can guide on Heparin effect on the clotting, if the patient needs clotting factors such as platelets, Cryoprecipitate or plasma, and if the patient’s clots are breaking down too quickly requiring treatment. As the results are quicker than formal lab results, it means we can treat any deficiencies more quickly or find that no blood products are required at that time. By having the results quickly it can also give us a real time report of whether our interventions have been successful, or can allow invasive procedures to happen more quickly. 

Since having TEG to guide us, it has helped with clinical decision making in a range of patients from post-operative cardiac patients, to patients on Extracorporeal Membranous Oxygenation (ECMO) and patients on Continuous Renal Replacement Therapy (CRRT). TEG has allowed us to react more quickly to patients who are bleeding, enabling us to give the blood product or treatment to most effectively correct the issue in a timely manner. It allows us to tailor the transfusion process for each individual patient, increasing the chances of correcting a coagulopathy and should prevent wasteful use of blood products. 

Several nurses on PICU have been trained in how to use the machine and start a test, and ECMO specialist nurses have been taught about basic interpretation of the results provided. Medics on the unit are able to then look at the results and interpret them to meet patient needs. 

 

 

Photos of TEG machine