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Obtaining Electrocardiogram (Ecg) : Clinical Nursng Skills

An electrocardiogram (ECG) measures the heart's electrical activity by detecting electric currents on the skin via electrodes attached to limbs and chest. The data is graphed as waveforms to identify issues like ischemia, arrhythmias, enlargement, or toxicity. To obtain a 12-lead ECG, electrodes are applied to specific sites on the limbs and precordium after cleaning the skin. The machine is then used to record the traces automatically and the ECG paper is labeled with relevant information.

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91 views

Obtaining Electrocardiogram (Ecg) : Clinical Nursng Skills

An electrocardiogram (ECG) measures the heart's electrical activity by detecting electric currents on the skin via electrodes attached to limbs and chest. The data is graphed as waveforms to identify issues like ischemia, arrhythmias, enlargement, or toxicity. To obtain a 12-lead ECG, electrodes are applied to specific sites on the limbs and precordium after cleaning the skin. The machine is then used to record the traces automatically and the ECG paper is labeled with relevant information.

Uploaded by

Swillight me
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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CLINICAL NURSNG SKILLS

OBTAINING ELECTROCARDIOGRAM (ECG)

Electrocardiography (ECG) measure’s the heart’s electrical activity. Electrodes attached to the
skin can detect these electric currents and transmit them to an instrument that produces a record (the
electrocardiogram) of cardiac activity. The data are graph as waveforms. ECG can be used to identify
myocardial ischemia and infarction, rhythm and conduction disturbances, chamber enlargement,
electrolyte imbalances, and drug toxicity.

EQUIPMENT:

 ECG Machine
 Recording Paper
 Disposable Pregelled Electrodes
 Adhesive Remover swabs
 4 x 4 gauze pads
 Soap and water, if necessary
 Bath Blanket
 PPE as indicated

PROCEDURE:

1. Verify the order for an ECG on the Patient’s Medical Record


2. Gather all equipment and bring to bedside.
3. Perform Hand Hygiene and put on PPE, if indicated.
4. Identify the Patient.
5. Close Curtains around bed and close the door to the room, if possible. As you set up the
machine to record a 12-lead ECG, explain the procedure to the patient that the test records the
heart’s electrical activity, and it may be repeated at certain intervals. Emphasize that no
electrical current will enter his or her body. Tell the patient the test typically takes about 5
minutes. Ask the patient about allergies to adhesive, as appropriate.
6. Place the ECG Machine close to the patient’s bed and plug the power cord into the wall outlet.
7. If bed is adjustable, raise bed to comfortable working height, usually elbow height of the
caregiver. (VISN 8 Patient Safety Center, 2009)
8. Have the patient lie supine in the center of the bed with the arms at the sides. Raise the head
of the bed, if necessary, to promote comfort. Expose the patient’s arms and legs, and drape
appropriately. Encourage the patient to relax the arms and legs. If the bed is too narrow, place
the patient’s hands under the buttocks to prevent muscle tension. Also use this technique if the
patient is shivering or trembling. Make sure the feet do not touch the bed’s footboard.
9. Select flat, fleshy areas on which to place the electrodes. Avoid muscular and bony areas. If
the patient has and amputated limb, choose a site on the stump.
10. If any area is excessively hairy, clip the hair. DO NOT SHAVE HAIR. Clean excess oil and
other substances from the skin with soap and water and dry it completely.
11. Apply the limb lead electrodes. The tip of each lead wire is lettered and color-coded for easy
identification. The yellow (or RA/R) lead goes to the right arm; the black (or RL/RF) lead goes
to the right leg; the red (or LA) lead goes to left arm; the green (or LL) lead goes to Left leg.
Peel the contact paper off the self-sticking disposable electrode and apply directly to the
prepared site, as recommended by the manufacturer. Position disposable electrodes on the
legs with the lead connection pointing superiorly.
12. Connect the limb lead wires to the electrodes. Make sure the metal parts of the electrodes are
clean and bright.
13. Expose the patent’s chest. Apply the precordial lead electrodes. The tip of each lead wire is
lettered and color-coded for easy identification. The brown (or V1 to V6) leads are applied to
the chest. Peel the contact paper off the self-sticking disposable electrode and apply directly to
the prepared site, as recommended by the manufacturer. Position chest electrodes as follows:
 V1- Fourth intercostal space at right sternal border
 V2- Fourth intercostal space at left sternal border
 V3- Halfway between V2 and V4
 V4- Fifth intercostal space at the left midclavicular line (just an inch below the nipple)
 V5- Fifth intercostal space at anterior axillar line (halfway between V4 and V6)
 V6- Fifth intercostal space at midaxillary line, level with V4
14. Connect the precordial lead wires to the electrodes. Make sure the metal parts of the
electrodes are clean and bright.
15. After the application of all the leads, make sure the paper speed selector is set to the standard
25m/second and at the machine is set to full voltage.
16. If necessary, enter the appropriate patient identification data into the machine.
17. Ask the patient to relax and breathe normally. Instruct the patient t lie still and not to talk while
you record the ECG.
18. Press the AUTO button. Observe the tracing quality. The machine will record all 12 leads
automatically, recording three consecutive leads simultaneously. Some machines have a
display screen so you can preview waveforms before the machine records them on paper.
Adjust waveform, if necessary. If any part of the waveform extends beyond the paper when
you record the ECG, adjust the normal standardization and repeat. Note this adjustment on the
ECG strip, because this will need to be considered in interpreting the results.
19. When the machine finishes recording the 12-lead ECG, remove the electrodes and clean the
patient skin, if necessary, with adhesive remover for sticky residue.
20. After disconnecting the lead wires from the electrodes, dispose of the electrodes. Return the
patient to a comfortable position.
21. Clean ECG Machine, per facility policy. If not done electronically from data entered into the
machine, label the ECG with patient’s name, date of birth, location, date and time of recording,
and other relevant information, such as symptoms that occur during the recording.
22. Remove additional PPE, if used. Perform Hand Hygiene.

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