Download Treadmill Exercise Stress Echo Procedure

Treadmill Exercise Stress Echocardiography Procedure
Policy and Procedure
Purpose:
To provide guidelines and information to ensure best practice.
Procedure:
Pre test
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Prior to study date, patient will be notified by phone or mail with the date and
time of test, instructions to wear comfortable clothing and shoes, and a
reminder to have someone available to drive them home.
On arrival, after introductions and patient identification confirmed, patient will
receive a full explanation of the test procedure and potential risks, with the
opportunity to ask questions
A verbal and/ written consent must be obtained to continue
Test
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Patient will be required to disrobe from the waist up and don a gown open in
the front
12-lead ECG hook up is attached ensuring a good signal with appropriate
prep to the skin
The Technologist will take standing and supine ECGs at rest for baseline
Documentation of patient height, weight, age, resting B/P and current
medications
A cardiac history is taken and recorded for the reading Cardiologist
Ensure patient is wearing comfortable shoes to walk in
Use tissue harmonics (reduces near field artifact, improves resolution,
enhances myocardium, and improves endocardial border definition)
Decide early the need for a contrast agent, used with each acquisition
The Sonographer acquires digital loops of the imaging views Apical 4ch, 2ch,
ALAX, PLAX and PSAX at rest. The machine preset should have a
continuous capture or stacking function.
Choose either the Bruce or the Modified protocol
Reinforce instructions and explanation of treadmill format just before starting
test
Remind patient to speak up if having any symptoms or concerns while on the
treadmill
Remind patient of increase in incline and speed about 10 seconds before it
occurs
Encourage patient to stay on treadmill to reach or surpass the target heart
rate
Check patient B/P each stage and document
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Continually watch 12-lead ECG for arrhythmias and ST changes
Stop treadmill when test end point has been reached
Get patient back onto bed in a left lateral position so the Sonographer can
acquire peak images while heart rate is at its maximum
Continue to monitor B/P and any symptoms
Complete the test with post imaging when heart rate is below 100
beats/minute and document.
Test End Points
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Reached or surpassed target heart rate
Drop in systolic blood pressure from baseline despite an increase in workload
ST segment or QRS changes such as excessive ST depression (> 2 mm of
horizontal or down-sloping)
S-T elevation > 1 mm in leads without diagnostic Q waves (other than V1 or
AVR)
Arrhythmias: ventricular tachycardia, multifocal frequent PVCs, heart block
Severe symptoms: moderate to severe angina, presyncope, ataxia, pallor with
unwell feelings
Machine technical difficulties—patient safety is a priority
Patient refuses to continue
Policy
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Respect patient’s modesty by draping throughout the test
Respect patient’s right to refuse test or stop upon request
Ensure proper test supervision by Physician, location and availability prior to
starting the test
Patients ability to walk on treadmill should be assessed by staff as early as
patient walking down the hall. Need to change test type should be discussed
and approved by the supervising Physician.
Ensure requisition filled out and appropriateness of test indication
Confidentiality: test results not to be given to patient in a preliminary format
Use of contrast if unable to see any of the walls of the myocardium to ensure
a complete study
Sonographer must have a strong knowledge base of coronary artery anatomy
and distribution, and what LV walls are affected
Technologist must have a strong knowledge base for reading 12 lead ECGs
(i.e. arrhythmias, S-T changes) and be able to monitor B/P and symptoms for
the Sonographer
Medications and equipment available to treat and monitor if patient has
symptoms
Crash cart is in close proximity and staff aware of emergency response
protocols
Appropriate room size and current equipment, to ensure patient safety in an
emergency situation
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Preprinted order forms preferred for the use of contrast, oxygen,
nitroglycerine and written instructions for administration
Treatment of Symptoms
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Moderate or severe angina: stop test, return patient to the bed, do an
immediate blood pressure, apply oxygen--if supervising Physician is nearby,
have someone bring him into the room for assessment of 12 lead ECG and
vitals, and give Nitroglycerine if ordered
S-T depression of > 2 mm or elevation > 1 mm: stop test and return to bed
doing immediate images and monitoring vitals and symptoms
Arrhythmias as listed: stop test and return to the bed monitoring 12 lead ECG
until settled; if sustained life threatening arrhythmias – call a code
Presyncope, dizziness, unwell feeling: stop test, return to bed and monitor
vitals