Page 2253 - Cote clinical veterinary advisor dogs and cats 4th

Holter/Cardiac Event Monitoring 1121

presence or absence of signs of congestive the sternum) and two patches on the right, ○ If a Holter vest is not available, the monitor
heart failure leaving a one-half inch to an inch between is held in a dorsal midline location, and
VetBooks.ir • The monitor itself is checked for proper electrode snaps are all facing in the same incorporating the wires and monitor such
2-inch tape is wrapped around the chest,
each electrode. For taping ease, make sure
Monitor use:
that they emerge at the dorsal midline.
function before preparing to install it on
direction. For very active patients, a tiny
the animal. These instructions are usually
be placed on opposite ends of the adhesive
sent with the monitor. amount of tissue glue (<1 full drop) can ○ Cast padding or gauze is wrapped over the
tape, around the thorax, as well as cranial
• Discussion of care of the monitor with the band of each electrode patch. to the shoulders in a figure-eight pattern,
owner: the monitor must stay dry, clean, • Secure electrodes with 1-inch or 2-inch white creating a vest of bandage material. The
intact, and undamaged. tape. Wrap the tape all the way around the monitor is included in this layer.
• It is customary to have the owner leave a chest, covering the electrodes on both sides ○ Esmarch-type (e.g., Vetrap) bandage
deposit in the sum of the replacement cost but leaving snaps exposed. material is then wrapped over the gauze
of the monitor before leaving the hospital • The leads are attached to the patches accord- in a similar fashion.
with the machine. ing to the color scheme usually shown in the ○ Occasionally, elastic cotton adhesive
inside of the Holter recorder or within the (Elastikon-type) bandage material
Possible Complications and instructions. Pressing the wire attachments is used along the cranial and caudal Procedures and Techniques
Common Errors to Avoid directly onto the patches can be painful to borders of the Vetrap to secure to the
• Wet monitor: no swimming or bathing the animal and is not recommended. Rather, animal.
during the recording period. In the rain, a after the patch is attached to the skin, the ○ Alternatively, a purpose-made Holter vest
plastic bag should be placed over the monitor patch and underlying skin are elevated with for dogs can be used.
by the owner. the finger, and the electrode is pressed into ○ The monitor’s event button should still
• Damaged/chewed monitor or wires: if the the snap between thumb and forefinger, not be visible and accessible to the owner,
owner observes the animal damaging the between the thumb and the dog. If using but connections onto the thorax, loops
monitor, an immediate recheck is warranted. a vest, put Holter monitor in vest pocket of wire, and the rest of the monitor itself
The equipment can be examined, and sub- and pull leads through before attaching to should be protected.
sequently, the monitor may simply be more patient. • If a clock setting can be adjusted on the
heavily wrapped to prevent damage, or the • After the leads are connected, the wires monitor, it is set to the current time. If not,
monitoring period may be terminated and are gathered on top of the spine, with the the times at which the battery was installed
the monitor removed. cable exiting to the right side (most Holter and the recording began are noted as time
• Unstuck electrode patches or poor electrode vests have the recorder pocket on the right zero in the medical record.
patch contact with skin: prevented by clean- side) and taped with 2-inch tape to the tape • Instruct the owner to keep a diary of the
ing and preparing the skin with isopropyl around the chest. The only wire left exposed dog’s activities, including the time of the
alcohol before patch placement or with use is the cable that attaches to the recording observed activity. This includes normal
of tissue glue in extreme cases. system. If patient has long fur, cast padding activities and events thought to be of clini-
• Monitoring period is inexplicably shorter can be applied under the tape. cal relevance. The owner also may press the
than expected: prevented by using new • The monitor is attached to the animal as event button on the monitor if an episode
batteries every time. For audiotape Holter follows: of apparent significance (e.g., collapse)
monitors, it is important to ensure that
the audiotape is not put into the monitor
backward.
• Poor triggering of event button (Holter) or
record button (event monitor): prevented by
carefully showing the owners how to trigger
the event and record buttons on the monitor
at the time of installation
• Letting batteries run out, causing the cap- A B C D
tured events to be deleted (event monitor):
clients need to return 1 day before expected
end of battery life to replace battery.

Procedure
Holter monitor (see Video):
• The animal’s apex beat (heartbeat on the
thorax) is palpated bilaterally. These will be
the sites of electrode patch placement. E F G
• The hair is clipped vertically over these areas,
starting close to the sternum and working
upward to ensure a generous clip; there must
be room for the electrode patches and a few
centimeters of space separating them.
• The hairless skin is wiped clean with isopropyl
alcohol–soaked gauze or cotton and allowed
to dry completely. Technician tip: the patient H I J
should be standing throughout application HOLTER/CARDIAC EVENT MONITORING A-J: Top row, Electrode patch placement for Holter monitor.
to ensure proper positioning of the leads Electrode connecting tips on the ends of Holter monitor wires should be arranged as follows: on dog’s right
and for taping purposes. (top to bottom), black, white, and on the dog’s left (top to bottom), red, green, brown. Middle row, Illustration
• The patches are attached to the animal’s skin: of gauze, taping, and Vetrap for Holter monitor placement if Holter vest not available. Bottom row, Illustration
three patches on the left (starting just left of of Holter monitor placement with a Holter vest.

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