ELECTROCARDIOGRAM (ECG)

Electrocardiogram or electrocardiograph is a diagnostic tool used in

assessing the cardiovascular system.
TYPES OF ECG
1. 12 Lead ECG (12LECG)
Commonly used to diagnose myocardial ischemia or infarction
2. 15 Lead ECG
Three (3) additional chest leads across the precordium
3. 18 Lead ECG
early detection of myocardial ischemia and injury
WAYS TO OBTAIN AN ECG
1. Standard 12 Lead ECG
V1 > 4th intercostals space, right sternal border (Red)
V2 > 4th intercostals space, Left sternal border (yellow)
V3 > diagonally between V2 and V4 (green)
V4 > 5th intercostal space left mid-clavicular line (brown)
V5 > same level as V4 anterior axillary line (black)
V6 > same level as V4 and V5 mid-axillary line (violet)
2. Hardwire Monitoring
3-5 electrodes ( cardiac monitor)
3. Telemetry
Small box that the patient carries and continuously transmits
ECG information by radio waves to a central monitor elsewhere
( wireless)
4. Holter Monitor
10-24 hours
small, lightweight tape recorder like machine,
5. Trans-telephonic Monitoring
The patient attaches a specific lead system for transmitting the
signal and places a telephone mouth piece over the transmitter
box.

ELECTROCARDIOGRAM LEAD
PLACEMENT
A. Limb electrode placement
LA
RA
RL
LL

Left Arm
Right Arm
Right leg
Left Leg

LA
RA
RL
LL

B.Standard 12 Lead ECG Placement

C. 15 Lead ECG Placement

Yellow
Red
Black
Green

D. 18 LEAD ECG PLACEMENT

ECG PAPER

(Indicate the Name, age and the initial BP of the patient in the lower part of the ECG paper)

CARDIAC MONITOR

PROCEDURE:
1. Verify the order for the ECG in the client's chart.
2. Confirm the client's ID by checking two client identifiers according to
your facility's policy.
3. Provide privacy and explain the procedure to the client. Explain that
the test records the heart's electrical activity and that it may be
repeated at certain intervals. Emphasize that no electrical current
will enter the body. Tell the client that the test typically takes about 5
minutes.
4. Wash your hands.
5. Place the ECG machine close to the client's bed and plug the cord
into the wall outlet or, battery-operated, ensure that it is functioning.
Turn on the machine and input required client information. If the
client is already connected to a cardiac monitor, move the
electrodes to accommodate the precordial leads.
6. Have the client lie supine in the center of the bed with arms at his
sides. You may raise the head of the bed to promote comfort.
Expose the arms and legs and cover the client appropriately. The
arms and legs should be relaxed.
7. If the bed is too narrow, place the client's hands under his buttocks.
8. Select flat, fleshy areas to place the limb lead electrodes. Avoid
muscular and bony areas. If the client has an amputated limb,
choose a site on the stump.
9. If an area is excessively hairy, clip it. Clean excess oil or other
substances from the skin with soap and water.

10. Apply disposable electrodes to the client's wrists and to the medial
aspects of the ankles. Apply the pre-gelled electrode directly to the
prepared site, as recommended by the manufacturer's instructions.
To guarantee the best connection to the lead wire, position
disposable electrodes on the legs with the lead connection pointing
superiorly.
11. Expose the client's chest. Put a pre-gelled electrode at each
electrode position. If your client is a woman, be sure to place the
chest electrodes below the breast tissue. In a large-breasted
woman, you may need to displace the breast tissue laterally.
12. Connect the lead wires to the electrodes. The tip of each lead wire
is lettered and color-coded for easy identification. The white or RA
lead wire goes to the right arm; the green or RL lead wire, to the
right leg; the red or LL lead wire, to the left leg; the black or LA lead
wire, to the left arm; and the brown or V1 to V6 lead wires, to the
chest electrodes.
13. Check to see that the paper speed selector is set to the standard 25
mm/second and that the machine is set to full voltage. The machine
will record a normal standardization marka square that is the
height of two large squares or 10 small squares on the recording
paper.
14. Ask the client to relax and breathe normally. Tell the client to lie still
and not to talk when you record the ECG.
15. 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
that you can preview waveforms before the machine records them
on paper. If any part of the waveform height extends beyond the
paper when you record the ECG, adjust the normal standardization
to half standardization. Note this adjustment on the ECG strip
because this change will need to be considered in interpreting the
results.
16. When the machine finishes recording the 12-lead ECG, remove the
electrodes and clean the client's skin. After disconnecting the lead
wires from the electrodes, dispose of the electrodes.

17. Assist the client to a comfortable position. Ensure the bed is in a

low position.
18. Remove any remaining equipment and wash your hands.
19. Document in your notes the test's date and time and significant
responses by the client. Verify the date, time, client's name, and
assigned ID number on the ECG itself. Note any appropriate clinical
information on the ECG.
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LIFESPAN CONSIDERATIONS

Infant/Child
- When obtaining a pediatric ECG enlist the help of the parents, if
possible, try distracting the child to keep them still during the
tracing. If artifact from either the arm or leg is a problem try
moving the lead to a more proximal position on the extremity.
Older Adult
- In older adults remove the electrodes carefully to prevent tearing
of the skin, as adults grow older the skin becomes thinner and
tears easily.
Small areas of hair on the client's chest or extremities may be clipped;
clipping usually is not necessary.
If the client's skin is exceptionally oily, scaly, or diaphoretic, rub the
electrode site with a dry 4" 4" gauze pad or washcloth before
applying the electrode to help reduce interference in the tracing. During
the procedure, ask the client to breathe normally. If the respirations
distort the recording, ask the client to hold his breath briefly to reduce
baseline wander in the tracing.
If the client has a pacemaker, you can perform an ECG with or without
a magnet, according to the physician's orders. Be sure to note the
presence of a pacemaker and the use of a magnet on the strip.