Procedure: ECG Flashcards
(28 cards)
How do you explain to a patient what an ECG is?
A quick and simple test to check the electrical activity of the heart, including the heartrate and heartbeat pattern
How do you explain to a patient what an ECG procedure includes?
‘It includes me just putting some sticky pads on different areas on your chest and each of your legs and arms, then I will attach the ECG wire to these pads so that the monitor can process the electrical signals’
After gaining consent from the patient, what 3 things should you ask them?
‘Would you like to have a chaperone present?’
‘Are you okay to remove your shirt and roll up your trousers so that I can attach the sticky pads?’
‘Do you have any chest pain?’
How should the patient be positioned for an ECG?
Laying on bed at 45 degrees angle
What 2 factors should you check for on the patient to ensure that there will be good skin contact to the electrode pads?
Hairy area: Should shave until smooth so that pad sticks directly onto skin
Sweaty/clammy skin: Use towel/tissue to wipe area until dry
Before attaching the electrode pads, what should you check?
Expiry date of the electrode pads
How many chest leads and limb leads are there for a 12-lead ECG?
6 chest leads
4 limb leads
Where does the V1 electrode attach on the chest?
4th intercostal space on right sternal edge
When attaching the chest electrodes, which order should you go in and how do you find the correct starting anatomical location?
- Locate the angle of louis: Bony bump in middle of chest (joint between manubrium and sternum)
- Angle of louis is almost directly in line with 2nd ICS (2nd ICS is slightly below), so count 2 down and find 4th ICS
- 4th ICS should be slightly above or in line with nipple
- Should do V1,V2,V4,V3,V5,V6
Where does the V2 electrode attach on the chest?
4th intercostal space on left sternal edge (directly opposite V1)
Where does the V4 electrode attach on the chest?
5th intercostal space in left mid-clavicular line
Where does the V3 electrode attach on the chest?
Between V2 and V4 electrodes
Where does the V5 electrode attach on the chest?
5th intercostal space in left anterior axillary line (beginning of armpit)
Where does the V6 electrode attach on the chest?
5th intercostal space in the mid-axillary line (middle of armpit)
How should you make sure that the V4,V5,V6 electrode pads are placed?
In a horizonal line
Don’t follow the 5th ICS as this will start to slant upwards
Where should each of the limb lead electrode pads be attached?
Red (Right arm): On right shoulder
Yellow (Left arm): On left shoulder
Green (Left leg): On left ankle
Black (Right leg): On right ankle
In which direction should you apply the electrode pads?
So that the tag is pointing towards patient’s center
This reduces tension when ECG leads are attached
After applying the electrode pads, how do you attach the ECG leads?
- Ask patient if it is okay if you place the lead outlet on their legs, so that it is in the centre between all electrode pads
- Attach all chest leads
- Attach all limb leads
How do you use the ECG monitor?
- Turn on monitor
- Check that paper is loaded into monitor and make sure that paper speed is 25 mm/s and voltage is 10 mm/mV
- Press ‘START/ECG/RECORD’ button to print ECG tracing
- After printing ECG, turn off monitor
Before recording the ECG, what should you tell the patient?
‘I am going to start recording the ECG now, please try to be as still as possible and to not talk, as movement can affect the recording’
After you have printed the ECG, what should you check for on the trace?
That trace is free of any artifacts: Disturbances or distortions in the tracing that are not related to the heart’s electrical activity
Give 4 common reasons for artifacts on an ECG trace?
Loose leads: Noisy or distorted signals
Patient movement: Intermitted contact loss between electrode pad and skin
Muscle tremors: Cause spikes
Baseline wander: Wavy or undulating baseline due to patient breathing or small movement
After printing the ECG recording, which 4 things should you document on it?
- Patient details, DOB, hospital number
- Date and time of the ECG
- Patient’s blood pressure and pulse at the time of ECG
- Indication for ECG
If an ECG trace has artifacts in it, what 2 things should you do?
- Check that there is good skin contact with electrode pads
- Record another ECG trace
