What can cause the loss of the electrocardiogram (EKG) signal from hardwired bedsides and also telemetry units?

There are several possibilities. You can narrow things down by first connecting a simulator to the electrode leads and see what the signal looks like. Obviously, the main trunk cable and the leads can cause loss of signal. This is probably the most common problem. Another culprit could be the lead patches, an issue that some clinicians are reluctant to believe. It is possible to have one bad patch out of an entire pack, and it's possible to have a couple of dried-out patches as a result of an old pack and a new one being combined. Ask the clinical staff about changing the patches. Once you determine the device is functioning, you should consider the patient—yes, the patient. It is possible that the patient is deteriorating enough that the monitor can no longer pick up the signal. It is also possible that there's a problem with the contact between patient and patch. Things like hair, lotion, and dry skin can contribute to bad patch adhesion. One thing that might also help is cleaning the skin, removing anything that might impede contact. Use a dry washcloth to wipe the area where the patch will be applied until the skin “blushes” and then connect the electrode.

If your hospital information technology (IT) department manages the wireless, I'd suggest building a relationship with them and learning what tools are available to troubleshoot the wireless system.

If a wireless telemetry pack is involved, it is possible to have an access point that is causing drop out. If your hospital information technology (IT) department manages the wireless, I'd suggest building a relationship with them and learning what tools are available to troubleshoot the wireless system. Let's face it: Biomeds are in daily contact with the nursing staff. Therefore, a biomed will most likely be called when there's a signal loss, even if it is an entire hall that does not work. So why not have the tools you need and be able to troubleshoot, to an extent, your immediate wireless area? I have on occasion seen a bedside that has a signal and a central station that has a less than desirable signal. This could be a network cabling issue or a bad network interface card (NIC). It depends how your system is designed. I have had the problem with both the CAT 5 cable and the NIC.

How would someone know at what temperature a blanket warming cabinet and a fluid warming cabinet should be set?

A common misconception is that The Joint Commission (TJC) has a standard for the temperature setting on fluid warmers and blanket warmers. That is a myth. TJC does, however, have a guideline requiring hospitals to have written plans concerning the effective, and safe operation of medical equipment, (EC 6.10 and 6.20).

The ECRI Institute recommends that blanket warmers be set at 130 degrees F and fluid warmers be set no higher than 110 degrees F. It is important to note that ECRI recommends storing fluids and blankets separately, with each unit having its own temperature control. In recent years, there have been studies on adjusting blankets to a higher temperature. Most studies have found that blankets can be heated to 200 degrees F without causing any patient harm. After considering the amount of heat lost in the time it takes to put the blanket on the patient, it's apparent that instances of patient discomfort, let alone harm, would be rare. Most injuries have occurred because of IV fluids being heated too high and patients getting burned through them. Because of this and as a patient safety advocate, I always recommend storing fluids and blankets separately. I have never had a manager or nurse disagree when this is explained.

About the Author

Becky Crossley, CBET, is a BMET III in the Biomedical Engineering Department at Susquehanna Health in Williamsport, PA. E-mail: bcrossley@susquehannahealth.org