Drew B J, Ide B, Sparacino P S
Department of Physiological Nursing, University of California, San Francisco 94143-0610.
Heart Lung. 1991 Nov;20(6):597-607.
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.
许多心律失常的诊断标准可从任何监测导联中观察到；然而，其他重要标准是“导联特异性的”，例如V1导联中的诊断性QRS波形态，有助于区分室性心动过速与伴有束支传导阻滞或差异性传导的室上性心动过速。因此，选择哪些导联进行床边监测有很大差别。我们的目的是确定护士选择哪些导联进行监测，以及导联放置的准确性。从美国重症护理护士协会成员的护士随机样本中，302人返回了一份监测问卷。平均重症护理经验为8.5年。单通道监测最常选择II导联（74%）；双通道监测最常选择II导联加V1导联（或MCL1导联）（87%）。只有37%的护士展示了获取其首选单导联的正确技术；展示获取其首选双导联正确技术的护士更少（13%）。这些结果表明，监测患者中诸如宽QRS波心动过速等心律失常的误诊可能是由不恰当的导联选择以及不准确的导联放置所致。
