National Telemetry Association®
N.T.A. Scope of Practice

  1. The NTA defines a telemetry technicians scope of practice as: Providing care to patients either directly, indirectly or remotely, through the reading and interpreting of their cardiac rhythms produced by 3 to 5 lead transmission via the electrical conductivity of the heart and taking the immediate necessary steps to notify the Physician or RN to ensure patient safety and promotion of health status via:
    (1) Knowledge and identification of a minimum of 31 cardiac rhythms:

    1. Normal Sinus Rhythm,
    2. Junctional rhythms,
    3. Sinus tachycardia,
    4. 3rd degree heart block,
    5. 2nd degree heart block,
    6. Mobitz Type II,
    7. Mobitz Type I,
    8. Ventricular Tachycardia,
    9. Atrial Tachycardia,
    10. Sinus Bradycardia,
    11. Premature Ventricular Contractions,
    12. Premature Atrial Contractions,
    13. Trigeminy,
    14. Bigeminy,
    15. Quadrageminy,
    16. Right Bundle Branch Block,
    17. Left Bundle Branch Block,
    18. Asystole,
    19. Pulseless electrical activity,
    20. Torsade’s de Points,
    21. Atrial Fibrillation,
    22. Atrial Flutter,
    23. Multi Focal Atrial Tachycardia,
    24. ST segment elevation Myocardial Infarction Anterior,
    25. ST segment elevation Myocardial Infarction Posterior,
    26. Wolf-Parkinson White,
    27. Ventricular Fibrillation,
    28. ST segment depression,
    29. T-Wave inversion,
    30. Supraventricular Tachycardia,
    31. Pacemaker rhythm

    * In addition to the recognition of the above mentioned rhythms, N.C.T.T. (Nationally Certified Telemetry Technicians) must also be able to recognize any combination of the 30 rhythms.

  2. Knowledge of correct lead placement on patient of both 3 and 5 lead telemetry monitor leads.
    1. correct technique of lead removal tabs from patient’s chest, maintaining patient comfort, dignity, safety, respect and attention to patient’s rights.
    2. cleaning of monitor and correct disposal of lead tabs
  3. Knowledge of how cardiac medications can affect heart rate and rhythm. Medications which each N.C.T.T. should know include but are not limited to the following:
    1. Digoxin, Lanoxin
    2. Atropin
    3. Amioderone
    4. Beta-blocker, Calcium channel blocker
  4. Knowledge of the pathophysiology of the heart and circulation.
  5. Knowledge of signs of and symptoms of hypoxia and how this affects the heart rhythm.
  6. Knowledge of hypokalemia/hyperkalemia, hypocalcemia/hypercalcemia, hyponatremia/hypernatremia, hyperchloremia, and how these fluctuations in osmolality can affect the heart muscle and consequently the heart rhythm.
  7. Maintain constant communication with team leader and or Nurse/Physician regarding patient’s health status. Communicate articulately the wave patterns of the patient to the team leader/Nurse/Physician in such a manner that is keeping with the use of correct medical terminology and asking questions which will help promote the patient’s health, while contributing observations both objective and subjective regarding the patient’s heart rhythm and any other pertinent observations.
  8. Recognize trending patterns and report changes immediately.
  9. Understand and apply critical thinking to data such as Oxygen saturation, blood pressure and pulse when displayed on certain telemetry monitors and know how to interpret changes in the vital sign values with respect to the patient’s safety, communicate these changes in vital signs immediately to supervisor, team leader, Nurse/Physician/
  10. Know how to measure and interpret the PR, QRS, QT, ST segment, pathological U waves and vertical and horizontal axis deviation while being able to measure heart rate using the 1500 rule.