HOLTER TEST

1. Statement of Purpose

1.1 To be able to set–up the Digitrak XT recorder before hooking it to the patient.

1.2 To be able to properly attach the electrodes and the Digitrak XT recorder to the patient.

1.3 To be able to provide information to the patient regarding care of the Digitrak XT recorder, patient
cable and belt clip or pouch.

1.4 To be able to remove the electrodes and recorder from the patient

1.5 To be able to download and save data from the Digitrak XT recorder

1.6 To be able to print the results of the holter test

1.7 To be able to clean and disinfect the equipment used

2. Definition of terms

2.1 Medical Equipment Cash Bond form: A written agreement between the patient and the clinic that the
patient will need to make a cash deposit for the equipment that will be used for his diagnostic test. The
form also states that the deposit will be refunded fully to the patient once the medical equipment is
returned without damages and it is functioning.

2.2 Digitrak XT holter kit: Composed of 1 Digitrak XT Recorder, 1 Patient cable with 5 electrodes, 1 belt clip
and 1 pouch with lace.

2.3 Digitrak XT recorder: A battery operated solid state recorder, designed for up to 168 hour (7 days)
continuous recording of ambulatory electrocardiograph (AECG) Data.

2.4 Patient cable: A cord that has five electrodes to be attached to the patient and is connected to the
Digitrak XT recorder on its other end.

2.5 Docking station: Serves as a USB to transfer data to and from the Holter application and the Digitrak XT
recorder.

2.6 Enter: The button on the Digitrak XT recorder with this symbol

2.7 Left arrow: The button on the Digitak XT recorder with this symbol

2.8 Right arrow: The button on the Digitrak XT recorder with this symbol

2.9 Up arrow: The button on the Digitrak XT recorder with this symbol

2.10 Down arrow: The button on the Digitrak XT recorder with this symbol
3. Equipment/materials/forms

3.1 Holter Computer, keyboard and mouse

3.2 Digitrak XT recorder

3.3 Docking station

3.4 Patient cable

3.5 Belt clip or pouch with lace

3.6 Battery, size AAA

3.7 Gloves, clean

3.8 Dry swab or tissue paper

3.9 Disposable electrodes

3.10 Disposable shaver

3.11 Tape

3.12 Soft cloth

3.13 Mild detergent

3.14 Adhesive tape remover

3.15 Patient gown

3.16 Tray

3.17 Medical equipment cash bond form

4. Policy statement

4.1 The test must be ordered by the doctor and verified by the nurse.

4.2 All patients must pay a deposit of 1000 SAR and sign the medical equipment cash bond form before
hooking the medical equipment to the patient.

4.3 The medical equipment cash bond form should be signed by the Accounting Manager, Mr. Mohammad
Salah.

4.4 Hand hygiene must be performed before touching a patient, before preparing the equipment and
supplies and after performing the procedure.

4.5 The time and date on the Digitrak XT recorder and the holter computer must be the same.
 4.6 Safety and warning information must be discussed to the patient and his significant others.

4.7 Patient leads must be removed from electrodes before defibrillation

4.8 Do not leave the battery in the recorder when it is not in use. Damage from corrosion could result.

4.9 Use of rechargeable battery is not recommended.

4.10 All battery to be used must be new for every patient. An alkaline battery is used for < 48 hours
recording time while a lithium battery is used for > 48 hours recording.

4.11 For best recording results, the patient should be instructed to avoid close proximity to heavy electrical
equipment or other sources of electromagnetic interference such as electric blankets, heating pads, etc.

4.12 The Digitrak XT recorder should not be immersed in water. The patient should be instructed not to
wear recorder in the shower or bath.

4.13 The Digitrak XT recorder supports an Early Out feature that allows a trained individual to stop a
recording before the selected recording time has elapsed. Failure to follow this procedure may result in the
loss of all recorded ECG data.

4.14 It is recommended that trained medical personnel handle the application of electrodes.

4.15 Use only electrodes designed for longer term Holter monitoring.

4.16 Proper preparation of the patient’s skin is absolutely essential for obtaining a quality ECG recording.

4.17 Apply electrodes as shown in the diagrams of the Monitor hookup kits, the electrode placement
diagrams included in the equipment guide, or as instructed by a physician.

4.18 Remind patients that the recorder contains confidential patient data and they should safeguard the
recorder while it is in their possession.

4.19 Store the recorders in a secure location when not in use.

4.20 Delete patient data from the recorder after it has been downloaded to the Holder application.

4.21 Do not use alcohol or acetone to clean lead wires as this can cause the wires to stiffen and the
insulating plastic to crack.

4.22 For problems with the recorder, refer to Digitrak Xt Recorder Instruction for use page 2-2 to 2-4. If your
issue is not addressed call the Response center.

5. Procedure
5a. Setting up the Digitrak recorder and hooking to the patient

5a.1 There is an order for a holter test.

5a.2 Patient will be guided to the reception area to pay for the test and to pay the deposit for medical
equipment cash bond. The invoice and the medical equipment cash bond form will be given to the patient
after paying. Check that the medical equipment cash bond form was signed by Mr. Mohammad Salah.

5a.3 Turn on the holter computer. Check that the keyboard, the mouse and the dual docking station are all
connected to the computer and are working properly.

5a.4 Do hand hygiene. Prepare the needed equipment and supplies for the holter test.

5a.5 The patient will then be escorted to the holter test room.

5.4 Identify correct patient. Welcome patient into the holter test room, greet and introduce self. Check if
there is invoice for the test and if the medical equipment cash bond form is signed.

5.5 Explain procedure for the holter test.

5.6 Show the holter test kit to the patient. Check the completeness of the equipment inside the kit. After
checking, tick the items that the patient will be bringing home on the medical equipment cash bond
form. The patient and the nurse will then sign it.

5.7 Connect the recorder on the docking station. Open the holder program on the computer. Once the
holter program is opened, chose “Tools” in the function toolbar. Click on “Recorder Utility”. Enter all of
the patient’s needed information based on his invoice while verifying it with the patient. Then click on
“Write to Philips Recorder”. A dialog box will appear confirming a successful access to the Philips
recorder. Click on “Ok”.

5.8 Remove the recorder from the docking station.

5.9 Ask patient to change into clinic gown.

5.10 Do hand hygiene. Wear gloves. Prepare patient’s skin prior to applying the electrodes. Clean and dry
the patient’s chest. Shave hairy area for electrode application only if the patient consented.

5.11 Attach the leads to the electrodes first before placing them on the patient. Then apply the electrodes
to the patient as follows:

Electrode Placement
th
Brown Level of 5 intercostal space, midsternum
Black Same level as the brown and white electrode, left mid-axillary line
Red Top of sternum (manubrium)
White Same level as the brown and black electrode, right mid-axillary line
Green Center of sternum or any convenient location
5.12 Make sure to press around the edges of the electrodes for it to stick properly on the patient’s chest.
You may ask the patient to stand up and march in place to see if there are loose electrodes. A tape may
be placed to reinforce the electrodes. Remove gloves. Do hand hygiene.

5.13 Insert the patient cable into the recorder. Press firmly.

5.14 Put a new size AAA battery on the recorder. The recorder turns on as soon as you put the battery.
Once the recorder is ready, a message “Press any key to start” is displayed on the screen.

5.15 Press any button to enter the menus. The patient information will appear on the screen. Once you see
that it is the correct patient information press the left arrow button and the enter button
simultaneously. The screen will now show you the lead status tab. For good connection, a “Leads OK”
message is displayed in the screen. Flashing dots on the lead status screen indicates a lead does not
have a good patient connection. When this happens, check for loose electrode connections.

5.16 To check the ECG signal quality, use the right arrow button to display the CH1, CH2, and CH3 tabs.
When all the leads are properly connected, the ECG waveform appears.

5.17 To set the desired record time (the DigiTrak XT recorder is able to record by 24, 48, 72 and 96 hours),
use the right arrow to go to the settings tab. The “Record Time” field is automatically selected. Use the
up and down arrows to cycle through the available record times. When the desired duration is
highlighted, press the enter button.

5.18 To set the time and date, use the right arrow button to display the Date/Time tab. Press the enter
button. Use the up and down arrow buttons to select the parameter to change (hour, minute, date, and
so on), and use the left and right arrow buttons to change the setting of the parameter. Press the enter
button to accept the changes.
5.19 When everything is set, we can now start the recording. To start the recording, use the left and right
arrow buttons to select the Start tab. The “Start recording” option is automatically highlighted. To select
it, press the enter button.

5.20 Once the recording starts, the recorder displays the date, current time, and the time remaining for the
recording as well as any lead or cable error, if present.

5.21 The belt clip or the pouch (whichever is preferred by the patient) will be used to attached the recorder
to the patient.

5.22 Discuss the following with the patient:

5.22.1 Registering an event – Press enter button once each time the event is felt. The marked
event time stamp appears on the recorder screen for 20 seconds then it is cleared from the
screen. It would be helpful to note what these events were (ex: chest pain, dizziness,
shortness of breath and others) in a piece of paper or in anything that is convenient to the
patient like cellular phone maybe.
 5.22.2 The electrodes, the patient cable and the recorder will always be attached to the patient
for the whole duration of the test. It will only be removed back in the clinic once the test is
finished.

5.22.3 Do not remove the battery of the recorder nor disconnect the patient cable from the
recorder. Do not also disconnect the leads from the electrodes. Do not remove the
electrodes from your chest.

5.22.4 The recorder should not be immersed in water. As much as possible, bathing is not advised
while undergoing the recording. Sponge bath can be suggested.

5.22.5 Avoid close proximity to heavy electrical equipment or other sources of electromagnetic
interference such as electric blanket, heating pads, and so on.

5.22.6 In cases when the recorder is soiled, just clean with Isopropyl alcohol 70 %. For the patient
cable, clean with a soft cloth with water only.

5.22.7 Medical equipment cash bond – The amount deposited for the medical equipment will be
fully returned as long as the medical equipment are returned complete and in good working
condition.

5.23 Assist the patient in changing back in his clothes. Again, check the recorder if it is still recording and if
there are no loose electrode connections.

5.24 If there are no loose connections, the recorder is recording well and the related documents are
complete, the patient may now take the Digitrak XT holter test kit home.

5.25 Instruct patient when to return and what to bring.

5b. Removing the electrodes and recorder from the patient

** Once the recording time is finished, the recorder will automatically shut down.
** For any instances that the recorder must be stopped before the selected time has elapsed, press the left
arrow and the enter button simultaneously. A menu will be displayed with choices, Stop Recording or Exit Menu.
Select Stop Recording and press the enter button. A message, “Shutting down please wait. Recording complete”
appears. The recording stops and the recorder shuts down.

1. Assist client into holter test room. Let patient sit. Take the medical equipment cash bond form from the
reception area.
2. Help patient change into a clinic gown.
3. Do hand hygiene.
4. Check connection of the leads and electrodes, the patient cable to the recorder and the presence of the
battery inside the recorder. All must still be connected.
5. Remove the electrodes from the patient’s chest. Clean and dry patient’s chest with dry gauze or tissue.
Directly throw the used electrodes in the trash bin. Place the recorder, patient cable and belt clip in a tray.
6. Check the equipments if complete and if there are no damages such as cracks. If complete and with no
damages, sign the medical equipment cash bond form.
7. Let patient change back into his clothes and send him back into the reception to claim his refund for the
cash deposit. Ask patient to wait in the waiting area until he will be called for the results of his test.
8. Quickly wipe the recorder and the belt clip or pouch with alcohol swab. The patient cable with be cleaned
with mild soap and water only. After disinfecting, allow to dry. Then put the equipments back in the DigiTrak
case.

5c. Downloading and saving data from the recorder

1. Turn on the holter computer. Launch the holter application.

2. Take the recorder.
3. Connect the recorder to the docking station.
A text “Preloading” appears in the lower right-hand corner of the computer screen.
4. Leave the recorder connected until downloading of the data is complete.
5. At this point, the patient will be called back into the room for the results and verification of some data such
as events experienced during the test.
6. When the data download is complete, click on “New” tab on the status tool bar. The patient demographics
dialog box will appear. Any wrong information entered can be edited in this part. After editing or if there is
nothing to be edited, click next.
7. The patient events recording dialog box will appear next. The events felt by the patient can be added in this
box. Ask the client what the event was and the time it was felt then log it in this part. There is a box for the
time, click on the up and down arrow to choose the time. Then on the box for the event, click on the event
felt. After choosing the time and event, click the add button below the time box.
8. Then after adding all the events, click next. **Choose the type of test then click on the finish button. A
dialog box with a message, “Scanning complete” will appear. Click on OK.
9. The raw ECG results will now be displayed on the holter application. This can be analyzed by the cardiologist.
10. To save the results of the test, there are two ways. First is saving the raw data. Click on the “File” tab on the
status toolbar. Then choose “Save As”. Rename the file with the patients MR number then click on the Save
button. The file will be saved in the holter test folder as a ZHR file.
11. The second way is saving it as a report. Click on the “File” tab on the status toolbar. Then choose “Save
Report”. Rename the file with the patients MR number then click on the Save button. A dialog box “PDF
option” will open, choose high quality then click OK. The file will now be saved in the holter test folder as a
PDF file.
12. Check presence of the results file in the holter results folder.
13. Remove recorder from the docking station and remove the battery. Discard battery.
14. Clean the recorder and put in back in its case.

5d. Printing the result

1. Open the holter result folder. It is in the desktop.

2. Choose the correct file. Open the file.
3. Turn on the printer. Make sure it is connected to the holter computer. Check availability of bond paper for
printing.
4. Click the “File” tab on the status toolbar. A list of options will appear on the left side. Click on print. Check
if the printer is connected and ready to print. Then click print.
5. Wait for the results to be printed and arrange or staple it.
6. Give the results to the doctor for interpretation.
7. Send patient in to the consultation room once the doctor calls the patient.
 5e. Cleaning and disinfecting the equipment

6. Responsibility

6.1 Physician: 5.1, 5.7, 5.24

6.2 Nurse: 5.2, 5.3, 5.4, 5.5, 5.6, 5.8, 5.9, 5.10, 5.11, 5.12, 5.13, 5.14, 5.15, 5.16, 5.17, 5.18, 5.19, 5.20, 5.21,
5.22, 5.23, 5.24, 5.25, 5.26, 5.27

7. References

7.1 Digitrak XT Recorder Instruction for Use