ECG 12 Lead

Question 1

PPE

Answer 1

Don appropriate PPE, and undertake
appropriate hand hygiene.

Question 2

Equipment check

Answer 2

Check electrodes are in date and
apply them to the electrodes prior to applying them to the patient’s skin.

Question 3

Indications

Answer 3

Patients presenting with a
cardiovascular or respiratory
complaint, or where cardiac rhythm
is suspected to be abnormal or
needs to be monitored.

Question 4

Contraindications

Answer 4

Do not perform if the patient is in
cardiac arrest. Assess the rhythm
via the defibrillator pads instead.

Question 5

Consent

Answer 5

Explain procedure and obtain
informed consent.

Question 6

Prepare patient

Answer 6

Place the patient in a semi-
recumbent or seated position.
Support feet and arms, legs
uncrossed.

Expose patient sufficiently for limb
or chest electrode application,
maintaining dignity and preventing
heat loss.

Prepare the skin, this will include
shaving at the electrode sites,
cleaning oily skin with an alcohol
wipe, and gently scraping the skin to remove the surface layer of dead
skin cells.
Patients with perfuse sweating may
cause poor electrode adhesion,
clean and dry skin with an alcohol
wipe or gauze

This will improve electrical
conduction.

Question 7

Place lime leads

Answer 7

Avoid placing electrodes over
tendons and major muscle masses.
Apply the limb leads to the wrists
and ankles where possible.
A more proximal location may reduce artefact in cases of patient movement.

Question 8

Place chest lead

Answer 8

Locate angle of louis and count down four intercostal spaces.

Locate fourth intercostal space,
immediately right of the sternum.
Place V1 electrode.
Locate fourth intercostal space,
immediately left of the sternum.
Place V2 electrode

Locate fifth intercostal space, mid-clavicular line. Place V4 electrode.
Locates mid-point between V2 and
V4. Place V3 electrode.
Locate fifth intercostal space, mid-axillary line. Place V6 electrode.
Locate mid-point between V4 and
V6. Place V5 electrode.

Question 9

Acquire ECG

Answer 9

Have patient remain
as still as possible, breathing normally
Press acquisition on ECG device.
Correctly enter patient details
as prompted (in 12 lead function)

Inspect ECG recording for sufficient
quality. Repeat if necessary.

Question 10

Report

Answer 10

Report on ECG rhythm and
diagnostic observations.