How are Zio (zio patch) patches placed on patients and are they done inpatient or outpatient?

Zio Patch Placement and Setting

Zio patches are designed for patient self-application and are used exclusively in the outpatient setting, with patches typically mailed directly to patients' homes for self-affixing without requiring healthcare worker placement. 1

Application Method

The Zio patch is specifically engineered as a self-adhesive device that patients can apply themselves without clinical assistance. 1 Key features include:

• The patch is a small 2 × 5-inch adhesive monitor that patients affix directly to their chest 2
• Patches can be mailed to patient homes and easily self-affixed, unlike Holter monitors with cables and electrodes requiring placement by healthcare workers 1
• No special training or healthcare worker involvement is needed for application 1
• The device can be worn continuously for up to 14 days without removal during exercise, sleeping, or bathing 2

Clinical Setting: Outpatient Only

Zio patches are exclusively an outpatient monitoring tool and are not used for inpatient monitoring. 1 The evidence clearly delineates:

• Home enrollment of prescribed ambulatory rhythm monitors like patch monitors can be obtained without in-person contact 1
• The device is part of outpatient ambulatory ECG monitoring strategies, not inpatient telemetry 1
• During the COVID-19 pandemic, the shift to mail-home applications was validated, demonstrating equivalent quality (7.8% artifact for in-clinic vs 8.3% for mail-home) 3

Comparison with Inpatient Monitoring

When traditional telemetry monitoring is not feasible in hospital settings (such as off-site or nontraditional hospital units), mobile cardiac outpatient telemetry (MCT) devices may be used as an adjunctive approach, but this represents a different technology than the Zio patch 1

Practical Application Algorithm

For patients requiring extended cardiac rhythm monitoring:

1. Prescribe the Zio patch through outpatient cardiology or primary care 1
2. The device is mailed directly to the patient's home 1, 3
3. Patient self-applies the adhesive patch to the chest 1, 2
4. Patient wears continuously for up to 14 days (median wear time 10.4 days) 4
5. Patient returns the patch by mail for analysis 2

Evidence Supporting Self-Application

Pediatric data demonstrates that mail-home self-application produces equivalent quality to in-clinic placement, with no significant difference in artifact percentage (8.3% mail-home vs 7.8% in-clinic, p=NS) 3. In a direct comparison with Holter monitors in 200 pediatric patients, the Zio patch showed less artifact (2.8% vs 5.6%, p<0.001) and 75% of patients preferred the Zio over the Holter due to lack of wires and ability to shower 5.

Common Pitfalls to Avoid

• Do not schedule patients for in-clinic placement - this defeats the convenience advantage and is unnecessary 1
• Do not attempt to use Zio patches for inpatient monitoring - they are designed for ambulatory outpatient use only 1
• Ensure patients understand they can shower and exercise with the patch - unlike Holter monitors, the Zio is waterproof and designed for continuous wear 2, 5