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Comment on this procedure
* Monitoring alarm parameter may be altered by critical care registered nurses, registered nurses under the supervision of a critical care nurse, duty Intensivist or duty Cardiologist.
* All patients required to be nursed in ICU/CCU are to be monitored as per "Monitoring Documentation" protocol.
* Principal of setting alarms: When contravened, an alarm will alert the nurse to a potentially dangerous change in the patient's condition.
* Conversely, inappropriately set alarms contribute to noise and stress which may distract the nurse unnecessarily from patient care.
* Alarm limits may require adjustment to suit individual patient needs so that adequate physiological heart rate (ECG), oxygenation or pressure alarms do not excessively contravene alarms.
* Alarm triggered recording is to be set for ECG only, other parameters may be recorded manually.
GENERAL ALARM LIMITS:
* At the commencement of each shift the nurse must check that the relevant alarms are on, and that the alarm limits are appropriate. Below a table lists the parameters to be monitored in ICU, and the recommended alarm limits to be set.
Parameters
Alarm Required
Reason
Limits Recommended
ECG
Yes
ECG is a useful indicator of haemodynamic function. ECG alarms should always be set. Note: ST segment alarms are not necessary as direct observations of ST segments is more practical.
Lower Upper
50bpm - 140
BP via arterial line
Yes (in critically ill patients)
Also a useful indicator of haemodynamic function. Mean arterial pressure is less subject to error due to overshoot (resonance) and is a more reliable guide to perfusion pressure. MAP alarms are therefore preferred.
Lower Upper
60mmHg - 120
SBP
90mmHg - 180
SpO2
Yes (in critically ill patients)
Provides early warning of hypoxemia.
Lower Upper
95%
PA
Yes
To alert staff to pulmonary hypertension or if wedges PA catheter.
PA systolic low alarm limit set at mean PCWP.
CVP
No
Not appropriate, ECG alarms are generally more useful.
ETCO2
No
Frequently subject to error. Vary variable in breath to breath. Prone to dampening by condensate.
Temperature
No
Temperature reading frequently subject to error
e.g. probe fallout, cold suppositories.
CO/SVR
No
Measurement of cardiac output is an isolated reading. Alarms therefore not required.
OUTCOMES:
* Alarm parameters are used as a safety measure to alert medical and nursing staff of potentially dangerous changes in patients condition.
* Alarm triggered recording of the ECG will occur giving substantive evidence of arrhythmias/excessive change in heart rate.
Reviewed April 1996
R : 18.2
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