Download VAMHCS Telemetry Guidelines

VAMHCS Telemetry Guidelines
Please note that telemetry should NOT be utilized as a surrogate for frequent vital sign monitoring.
Telemetry should be utilized for the detection or monitoring of dangerous arrhythmias. The need for
continued telemetry should be assessed at 48 hours and, if continued, every 24 hours thereafter.
Non-ICU level telemetry monitoring is recommended for the following conditions:
1.) ACS rule out with TIMI risk score > 3 (please see TIMI calculator below)
2.) Confirmed ACS by positive cardiac biomarker(s)
3.) Symptomatic or high risk arrhythmias:
- Marked sinus bradycardia ( < 40 bpm)
- 2nd degree atrioventricular block (Mobitz II)
- Symptomatic or sustained ventricular tachycardia (> 30 seconds)
- Supraventricular tachycardia
- Atrial fibrillation or flutter with rapid ventricular rate (>110 bpm)
4.) Prolonged QTc on EKG (> 500 ms)
5.) Acute decompensated CHF with severe NYHA Class IV symptoms
6.) Marked electrolyte abnormalities:
- Hypokalemia (K < 3.0)
- Hyperkalemia (K > 6.0)
- Hypomagnesemia (Mg < 1.3)
7.) Syncope evaluation
8.) Acute CVA or TIA evaluation
TIMI Risk Score Calculator (1 point for each risk factor)
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Age > 65
> 3 CAD risk factors
Known CAD (stenosis > 50% on cath)
EKG ST changes > 0.5 mm
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Positive cardiac biomarker(s)
Aspirin use in past 7 days
Severe angina
(>2 episodes in the past 24 hours)
Please note non-ICU level telemetry is NOT recommended for the following conditions:
Alcohol withdrawal, seizure, GI bleed, low risk ACS rule out (TIMI risk score < 2), symptomatic
hypotension without arrhythmia, symptomatic respiratory conditions, asymptomatic ventricular ectopy
without underlying heart disease, patients with ICD or PPM admitted for non-cardiac conditions, and
chronic rate controlled atrial fibrillation or flutter.
Updated 5/2015