ECG

Question 1

What is the equipment needed for an ECG?

Answer 1

Equipment:
 ECG machine with set of 10 wires and sufficient ECG paper in place
 Adhesive electrodes
 Alcohol Gel and Bin
 (Razor, Gloves, Sharps Bin, Alcohol wipes)
 Pen

Question 2

What is the steps to follow in setting up an ECG?

Answer 2

1. Wash hands with water or alcohol gel.
2. Introduce yourself to the patient.
3. Identify the patient and confirm identity with patient’s notes and any ECG form.
4. Explain what an ECG is and why it is being done.
5. Obtain verbal consent.
6. Draw the curtains round the patient’s bed, and ask the patient to remove clothing from
   upper half of body.
7. Position patient sitting on the couch supported at 450.
8. Adhesive electrodes do not stick well to hairy skin, so you may need to shave a small patch
   where the adhesive electrode is applied. If the patient is sweating try cleaning the skin with an alcohol wipe first. (If necessary, put on gloves and clean and shave the area where you will place the electrodes. Make sure you dispose of the razor safely in the sharps bin.)
9. Apply the 4 limb adhesive electrodes to each wrist and ankle.
10. Apply the 6 chest adhesives as shown in the diagram (these are the areas that you may
    need to shave.) Note: the terms C (chest) and V (vector) are interchangeable. i.e.C1-C6 and V1-V6meanthesame.

Question 3

How should the pads be places?

Answer 3

a)Place the C1 adhesive in the fourth intercostal space at the right sternal border. (Palpate down from the sternal angle.)
b) Place C2 adhesive in the fourth intercostal space at the left sternal border.
c) Place C4 adhesive in the fifth intercostal space on the midclavicular line.
d) Place C3 between, and equidistant to, C4 and C2.
e) Place C6 in left midaxillary line on the same horizontal level as C4. (not the same as 5th ICS)
f) C5 is placed halfway between C4 and C6.

Question 4

Once setup how is the ECG carried out?

Answer 4

11. Turn on ECG machine. (Usually the grey button.)
12. Sort out the ECG wires into limb wires and chest wires
13. Connect correct wire to each limb electrode adhesive.
    i. Right wrist –Red ii. Left wrist –Yellow iii. Left ankle –Green
    (RYG = Traffic lights)
    iv. Right ankle – Black (the earth)
14. Connect the chest wires in numerical order 1-6 to the chest electrodes.
    (As you attach the leads you will hear the heart rate beating.)
15. Enter patient ID details. See below.*
16. Ensure filter button is on to eliminate any electrical interference.
17. Check Speed and calibration.
18. Instruct the patient to remain still. Press the record (usually green) button.
19. Obtain the read out from the machine. Check quickly that it is an adequate recording, then
    disconnect the wires and ask patient to remove the adhesive electrodes and re clothe.
20. Ensure all required demographic data* is written on ECG and tidy up.
21. Thank patient and wash hands with alcohol gel or water.
22. Analyse the ECG recording methodically.

Question 5

How should patient identifiers be added to the ECG?

Answer 5

*N.B. Most ECG machines allow you to enter patient’s demographic data into the machine. However, some older machines do not have these functions. Please ensure that patient’s name, gender, identity number, date of birth or age, and date of ECG recording are either put in via the machine or added by hand on to the ECG print out. Indicate on ECG if patient had chest pain during the procedure.

Question 6

What is an electrocardiogram?

Answer 6

The ECG is a simple test, with 10 electrodes used to record 12 different views of your heart’s electrical activity.

Question 7

What is the usual speed of a moving paper strip?

Answer 7

25mm/sec

Question 8

Name the vertical plane leads?

Answer 8

aVF

Question 9

Name the horizontal plane leads?

Answer 9

Lead I

Question 10

Why is patient advised not to move while recording the ECG?

Answer 10

It is important to be relaxed and warm during an ECG recording because any movement, including shivering, can alter the results. Sometimes this test is done while you are exercising or under light stress to look for changes in the heart.

Question 11

Which electrodes are required for continuous cardiac monitoring?

Answer 11

Most commonly monitored leads are either Lead II or the modified chest lead 1 (MCL1)

Lead II is used more frequently because most of the heart’s electrical current flows toward its positive axis. This lead gives the best view of the ECG waves and best shows the heart’s conduction system’s activity.