American Journal of Critical Care. 2007;16: 360
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Atrial Electrograms After Cardiac Surgery
By
Linda Bell, RN, MSN and
Todd Sargood, Illustrator.
Atrial fibrillation is a frequent postoperative complication in cardiac surgery. The condition may be difficult for clinicians to differentiate when the patient has a rapid ventricular response (>150/min), among patients with a preexisting bundle branch block, and during monitoring of surface electrocardiographic (ECG) leads.
Atrial electrograms can be helpful in proper diagnosis of atrial fibrillation in this population when the atrial pacing wires are still in place.
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Here’s what you can do:
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A unit-based policy or procedure should be established to provide guidance for staff nurses on the cardiac surgery unit. Be sure to include the cardiac surgeons in the process. Information that should be included:
- Under what circumstances an atrial electrogram should be performed.
- What training and competency validation is required for nurses to perform the procedure.
- The equipment needed to perform the procedure.
- Patient education and preparation.
- Patient assessments prior to, during, and following the procedure.
- Reference materials for setup and documentation of the procedure.
- Follow-up patient management, including management of the pacer wires to provide for patient safety and prevention of microelectric shock.
Training for nurses also should include evaluation of the atrial electrogram in comparison with the surface ECG tracing to identify atrial arrythmias. Including the surgery residents and fellows in the training will foster collaborative practice and trust among members of the team.
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Other helpful resources:
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- Call the AACN Practice Resource Network at (800) 394-5995, ext 217.
- AACN Procedure Manual for Critical Care, 5th edition (Procedure 43, "Atrial Electrogram"; product #128150). Available online from the AACN Bookstore, www.aacn.org.
- AACN Protocols for Practice: Noninvasive Monitoring, 2nd edition (product #170680). Available online from the AACN Bookstore, www.aacn.org.
- Practice Standards for Electrocardiographic Monitoring in Hospital Settings: An American Heart Association Scientific Statement from the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young. Abstract available at www.ciruclationaha.org.
- American College of Chest Physicians Guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Abstract available at www.chestjournal.org.
Published as a supplement to the article by Miller and Drew, "Atrial Electrograms After Cardiac Surgery: Survey of Clinical Practice" (
Am J Crit Care. 2007;16:350–359[Abstract/Free Full Text]
). Figure originally published in: Wiegand DJL-M, Carlson KK, eds. AACN Procedure Manual for Critical Care, 5th ed, section 6, procedure 43, page 298. Copyright Elsevier, 2005.
Related articles in AJCC:
- Atrial Electrograms After Cardiac Surgery: Survey of Clinical Practice
- Jane N. Miller and Barbara J. Drew
AJCC 2007 16: 350-356.
[Abstract]
[Full Text]
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