New AliveCor KardiaMobile 6L And The Diagnostic Power Of Six Leads

The ECG has come a long way since Nobel prize winning Willem Einthoven invented the first practical electrocardiogram (ECG or EKG) in 1895. The 3 lead string galvanometer also known as the Einthoven galvanometer he introduced in 1901 was 7 metres long, required 5 operators and weighed over 270 kiliograms!

Although the original “Einthoven triangle” configuration which refers to the imaginary inverted equilateral triangle centered on the chest and the points being the standard leads on the arms and leg was chosen largely for convenience it is still in use today.

I wonder what Einthoven would make of the new AliveCor KardiaMobile 6L PMS Instruments have launched today?

Things have definitely come on in the 159 years since he was born.

The new AliveCor KardiaMobile 6L records a six lead 30 second clinically validated ECG using a smartphone or tablet and App.

At 9cm long and weighing 24 g the KardiaMobile 6L has two electrodes on the top and one on the bottom.

The two electrodes on the top are for your fingers, and the one on the bottom to contact the skin of your left leg.

To record a 6 lead ECG hold the KardiaMobile 6L in your hands, placing your fingers on the front electrodes then touch the third electrode to the skin of your left knee or ankle. It’s that easy.

Why six leads?

The 2 fingers and left leg configuration allow the KardiaMobile 6L to record Lead I, II, II, aVL, aVR, and aVF ECG leads which are known as the frontal plane leads recording vertical and lateral electrical forces. By looking at the axis through the heart each of the individual 6 leads records the ECG from a slightly different perspective giving 6 times more information than the original KardiaMobile 1 Lead.

That’s 6 more times data for the KardiaMobile App and for your Doctor to analyse and providing more visibility into certain arrhythmias that are leading indicators of cardiovascular disease

For example with the 6 leads of ECG data the KardiaMobile 6L records it could be possible to identify if there is any deviation of axis out of the normal range in the frontal plane and if P waves are present.

With the launch of the KardiaMobile 6L six really is better than one!

Hokanson Cuff Changes Are Ahead.

Hokanson whose range of vascular instruments, cuffs and accessories are distributed in the UK and Ireland by PMS Instruments recently announced some changes to their cuffs. All cuffs manufactured after 31st August 2017 will now be supplied with male bayonet connectors.

Hokanson vascular cuffs have been the standard in vascular laboratories and clinics throughout the world for over 40 years and as they have been using “leur” type connectors for many years why the change now?

As ever the idea is to make medical devices safer and in the case of “small bore connectors” which includes blood pressure and vascular cuffs minimize medical device tubing misconnections.

Small-bore connectors are parts used to connect medical devices such as tubing, syringes, IV lines and other accessories that deliver fluids and gases for patient care. Although thankfully rare, tubes using standard luer connectors but with different functions have in the past been mismatched and connected incorrectly.

In the USA the FDA provide several examples of this happening on their website including the case of a blood pressure cuff which was accidentally connected to an IV catheter.

The FDA, and the International Organization for Standardization (ISO), decided to take action and IEC 80369-5:2016 was published in March 2016 to provide specifications for the small-bore connectors used with blood pressure cuffs. Hokanson have standardised on a male bayonet connector.

The following cuffs will be affected.

Hokanson UDC/UPC cuffs, the DP and SC cuffs that currently come with a Luer connector will be changed to a bayonet connector. This includes the SC10, SC12, TMC7 and SC5.

Hokanson cuffs with D rapid version hoses (SC12D, SC12LD, etc.) will remain unchanged. CC thigh cuffs will come with the bayonet connectors, and that connector can be cut off for use with an E20 rapid cuff inflator Y-connector (as with the Luer).

We will be providing Permanent Conversion Kits as well as Adaptor Kits to ensure compatibility and allow you to use legacy leur connector cuffs. Conversion kits are for permanent conversion of cuffs already being used that will change them to the new standard bayonet connector. Adapter kits are for customers who want to use both Luer and bayonet connectors, until all cuffs in use have bayonet connectors.

There is no requirement requiring customers to remove or stop using products currently in use from the market.

Ambulatory blood pressure monitors. Are you getting good value?

The cost of ABPM monitors has fallen considerably in recent years but purchasers should check that there are no hidden extras and that the supplier is able to offer free technical support, installation training and advice to nurses who generally fit the monitor.

As some manufacturers offer expensive additional warranties or support contracts the true “whole life” running costs including maintenance should be factored in to the purchasing decision.

All modern 24-hour monitors like the Meditech ABPM-04, Meditech ABPM-05 and TM-2430 now use PC-based software and in most instances it is possible to attach the patient’s report to popular clinical management systems, such as EMIS and SystmOne.

Again it is worth checking that this is included and that there are no expensive annual licence fees or dongles required, as well as checking that multiple copies can be installed without additional cost.

An ABPM report should include, as a minimum, daytime and night-time averages, a list of BP data and trend graph on one or 2 sheets of A4 paper.

Normal mean levels for ABPM in adults are slightly lower than surgery readings at 135/85 for daytime average and 120/70 when asleep.

The results can usually be interpreted by suitably qualified clinicians. The latest version of CardioVisions that works with the Meditech ABPM-04 and Meditech ABPM-05 provides additional automatic analysis to the NICE 2011 guidelines and this can save time and ensure consistent reporting.

Ideally, the monitor should be able to use rechargeable batteries to minimise costs. A wide range of cuff sizes should be available but the adult and large adult will probably be used the most popular. Cuff barriers like those from TIDI can help keep cuffs hygienic and prevent soiling.

Most but not all companies will offer additional training if required.

As with any piece of medical equipment used in patient diagnosis, routine calibration and servicing is important. This should only be undertaken by authorised service technicians that have access to original manufacturer parts and test equipment.

With any ABPM this should be available in the UK from the supplier to avoid unnecessary downtime.

As with all things it’s unwise to pay too much but sometimes risky to pay too little.