ECG

Question 1

How should you explain an ECG procedure to a patient? How might this differ if your patient is female?

Answer 1

• An ECG is an electrical trace of the heart
• It involves placing some sticky pads onto your chest and limbs
• the sticky pads are then connected to the ECG machines which record the tracings
• the procedure does not involve any electricity, so you won’t get an electric shock
• female pt: offer a chaperone to be present during the procedure
• ensure the patient has understood all that you have said and gain consent

Question 2

What is the correct positioning and exposure for a patient during an ECG recording?

Answer 2

Position: 45°
Exposure:
- remove socks to expose ankles
- expose the chest

Question 3

How should the chest electrodes be placed?

Answer 3

1. clean the site with alcohol wipes and allow to dry prior to electrode application
2. V1 - 4th intercostal space on the right sternal edge
3. V2 - 4th intercostal space on the left sternal edge
4. V4 - 5th intercostal space on the mid-clavicular line
5. V3 - midway between V2 and V4
6. V5 - left anterior axillary line at the same horizontal level as V4
7. V6 - left midaxillary line at the same horizontal level as V4 and V5

Question 4

How should the limb electrodes be placed?

Answer 4

• place on a bony distal prominence on each limb
  1. Red: right arm - ulnar styloid process at the wrist
  2. Yellow: left arm - ulnar styloid process at the wrist
  3. Green: left leg - at the ankle on the medial or lateral malleolus
  4. Black/Brown: right leg - on the medial/lateral malleolus

Question 5

How is the trace recorded?

Answer 5

1. turn the ECG machine one (ensure there is paper loaded)
2. double check all the electrodes are attached in the appropriate positions
3. politely ask the patient to remain still and not talk during the recording (muscle activity will interfere)
4. press the button the machine to record the trace
5. if the trace is poor, double check the connections to ensure good skin contact

Question 6

How is the ECG examination completed?

Answer 6

1. once a good trace has been obtained, switch off the ECG machine
2. detach the leads from the electrodes
3. remove the electrodes
4. thank the patient and allow them to dress (offer help)
5. wash hands
6. label the ECG with he patient’s details and document findings