[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Vital signs and assessment](https://durgical.com/en/nursing/areas/vitals/) › Cardiac monitoring at the bedside: leads, alarms and rhythm changes to report # Cardiac monitoring at the bedside: leads, alarms and rhythm changes to report - Safe practice Continuous monitoring shows the heart rhythm only if electrodes are placed well and every alarm is checked at the patient before it is silenced. Updated Nov 12, 2026 ## Key points - 5-lead: RA and LA below the right and left collarbones, RL and LL on the right and left lower chest below the ribs, V1 at the 4th intercostal space, right sternal border. - For a 3-lead system, follow the electrode labels and the protocol. - Connect each wire by the letter and colour printed on it, as the protocol says. - Never silence or switch off an alarm without looking at the patient and the rhythm. - Report at once: ventricular tachycardia or fibrillation, asystole, complete heart block, new irregular rhythm, ST changes. ## What it is Bedside or telemetry monitoring records one or more ECG leads continuously so that dangerous rhythm changes are seen in time. Its safety depends on three things: correct electrode placement, alarms that are switched on and set for the patient, and a nurse who answers each alarm by looking at the patient first. Many alarms are false (artefact, a loose electrode) or do not need action, and that leads to alarm fatigue; the answer is better skin preparation, regular electrode changes and alarm limits adjusted to the patient, never silencing without checking. ## What it requires - A medical order and a unit protocol for who watches the monitor and how alarms are answered. - Electrodes on clean, dry, hair-free skin, changed as the protocol says (often daily). - Alarms switched on and audible, with limits set for the patient and their order. - A rhythm strip printed and interpreted at the start of the shift and with every change. ## Components - Electrodes, lead wires and the bedside or telemetry monitor. - Alarm types: rhythm alarms, rate limits and technical alarms such as a lead off. - False alarms (invalid signal) differ from non-actionable alarms (accurate but not clinically important); each needs a different fix. - Rhythm strip: usually a 6-second strip to estimate rate and rhythm. ## How it is applied (and why) - Check the order, identify the patient, explain the purpose and ensure privacy — consent and fewer interrupted readings. - Prepare the skin: clean, dry and hair-free, with electrodes stuck firmly — good contact reduces false alarms. - Place the electrodes for the lead system in use and connect them by their letters — misplacement distorts the rhythm. - Choose a lead with clear P waves and QRS complexes, check the rhythm and print a strip — a baseline to compare. - Set alarm limits for the patient and the order, and check they are audible — default limits may not fit. - At every alarm, look at the patient first: responsive, breathing, pulse; then the rhythm — a flat line may be a real arrest. - Fix technical causes such as a loose electrode or lead off, and change electrodes as scheduled — fewer false alarms. - Record and report strips at handoff and with any change — the team can see trends. ## In nursing practice - Any rhythm with an unresponsive patient and no pulse: call the emergency team and start resuscitation. - Ventricular tachycardia: fast, wide, regular complexes; check the pulse and call at once. - Ventricular fibrillation: a chaotic line with no clear complexes; the patient is in cardiac arrest. - Asystole: a flat line; check the patient and leads in seconds, and resuscitate if unresponsive. - Complete heart block: P waves and QRS complexes march independently; it can lead to arrest, so report at once. - New atrial fibrillation: irregularly irregular rhythm without clear P waves; assess blood pressure and signs of stroke and report. - New ST elevation or depression, especially with chest pain: urgent. - Heart rate very slow or very fast with symptoms (dizziness, low blood pressure, chest pain, confusion). ## Common mistakes - Silencing an alarm from the station without seeing the patient. - Leaving default alarm limits that do not fit the patient. - Connecting wires without checking their labels. - Leaving dry, old electrodes that cause repeated false alarms. - Assuming a flat line is a loose lead without checking the patient. ## Test yourself Think of the answer, then tap the question to see it. ## What is the first thing to do when a cardiac monitor alarms? Look at the patient: responsiveness, breathing and pulse. Only then interpret the rhythm and look for technical causes. ## Where is V1 placed in a 5-lead system? In the 4th intercostal space at the right sternal border. ## Which two measures reduce false monitor alarms? Good skin preparation (clean, dry, hair-free) and changing the electrodes as the protocol says, usually daily. ## What does ventricular fibrillation look like on the monitor? A chaotic, wavy line with no clear complexes. The patient has no effective heartbeat and is in cardiac arrest. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/cardiac-monitoring-at-the-bedside-leads-alarms-and-rhythm-changes-to-report/) ## Connections ## Related 4 - [Recording a 12-lead ECG](https://durgical.com/en/nursing/recording-a-12-lead-ecg/) - [Recognising deterioration and calling the rapid response team](https://durgical.com/en/nursing/recognising-deterioration-and-calling-the-rapid-response-team/) - [Basic life support from the nursing side](https://durgical.com/en/nursing/basic-life-support-from-the-nursing-side/) - [The crash cart: checks and organisation](https://durgical.com/en/nursing/the-crash-cart-checks-and-organisation/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Nursing Advanced Skills, 7.6: Checklist - Initiate Telemetry](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Advanced_Skills_(OpenRN)/07%3A_Interpret_Basic_ECG/7.06%3A_Checklist-_Initiate_Telemetry) (Open RN (Chippewa Valley Technical College), LibreTexts, 2023); [Nursing Advanced Skills, 7.4: ECG Patterns and Dysrhythmias](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Advanced_Skills_(OpenRN)/07%3A_Interpret_Basic_ECG/7.04%3A_ECG_Patterns_and_Dysrhythmias) (Open RN (Chippewa Valley Technical College), LibreTexts, 2023); [Testing physiologic monitor alarm customization software to reduce alarm rates and improve nurses' experience of alarms in a medical intensive care unit (Ruppel H et al.)](https://pmc.ncbi.nlm.nih.gov/articles/PMC6193710/) (PLoS One (open access, PMC), 2018). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/cardiac-monitoring-at-the-bedside-leads-alarms-and-rhythm-changes-to-report/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/cardiac-monitoring-at-the-bedside-leads-alarms-and-rhythm-changes-to-report/