Ecg Placement Retdem

ECG Placement - for proper electrode adhesion
8. Check that the ECG monitor is plugged in or

 THE ELECTROCARDIOGRAM (ECG turned on.
or EKG) is a routine diagnostic tool
being used to assess the electrical and 9. Attach cable to the monitor
muscular functions of the heart.
10. Limb Lead Application. Position the
 This is a relatively simple test to perform
limb electrodes. Connect the lead
but requires significant amount of
wires and attach the electrodes (color-
training to learn the interpretation of the
ECG tracing. coded & lettered)
ASSESSMENT a. Right arm – red color, labeled RA
1. Assess chest pain & its relationship to b. Right leg – black, labeled RL
ECG changes c. Left leg – green, labeled LL
2. Identify patient’s previous cardiac d. Left arm – yellow, labeled LA
history
3. Assess for signs & symptoms of fear &
anxiety
PLANNING
 Assemble & Identify all the
equipment.
 ECG monitor
 Lead wires and electrodes
 Cotton balls with alcohol
IMPLEMMENTATION
1. Review patient’s medical record,
including physician’s order
2. Explain procedure to the patient
(Assure that this is non- invasive)
3. Wash hands
4. Place patient comfortably in a supine
position on the examination table or
bed while exposing the arms and legs
5. Check and remove all metal objects
- This may interfere with test result
6. Clean the areas on the patient where
electrodes will be attachd with water or Chest Lead Application:
cotton balls with alcohol. Allow to dry or  Apply electrodes with electrodes gel
wipe with 4x4 gauze pad to the chest. Avoid positioning the
7. Shave areas which are excessively hairy electrodes directly on bone, which
will cause interference. In the female, Applying electrodes first allows the electrode
position the electrodes below the gel to contract and penetrate the skin surface.
breast tissue. If the breasts are large,
you may have to position the
electrodes laterally the axilla
12. Palpate for the Angle of Louis, the notch
between manubrium and body of sternum,
which is located in the 2 nd rib. Continue
palpitating downward to the fourth rib. Move
down slightly to the space between the fourth
and fifth ribs.
 Position lead V1, in the fourth intercostals
space, to the right of the sternum
 Position lead V2, directly opposite V1 at
the left sternal border.
14. Attach the correct lead wire to each

electrode
15.Ensure that the following have been
checked:
• The machine is plugged in or the
battery is fully charged.
• All leads are secured correctly, are
clean and in good working order
• There is paper in the device
 Positions lead V4 in the fifth intercostal • Filter is used (to help rule out
space at the midclavicular line. interference)
 Positions lead V3 halfway between V2 and • Ensure that speed is set to
V4. 25mm/sec
 Position lead V5 and V6 laterally to V4. • Ensure that calibration is set to
Position V5 in the anterior axillary line. V6 10mm/sec
is positioned in the midaxiary line.
16. If the thermometer has disposable, Ask the
patient to lie still and breathe normally and
stay still
17. Press the “AUTO” or “RECORD” button.
Check the tracing quality. If artifact is present,
try to correct the problem. It may be necessary
to use fresh electrodes. Run ECG strip.
18. Remove the wires and electrodes. Clean the
13. After applying the electrodes, enter electrode gel from the patient’s skin.
information required into the ECG cart.
19. Place patient in position of comfort.
20. Clean leads with an approved solution.
21. Wash Hands
22. Interpreting ECG strip:
 Determine heart rate by calculating (P-R
interval). Normal pulse is 60-10 Heart rate
is calculated by:
 Counting the number of small
boxes between R waves, and
dividing the number into 1500 or
300 divided by the big boxes. The
quotient is the ventricular heart
rate
23. Determine the regularity of rhythm. Check
if Complexes look alike and are equally spaced
using calipers
24. Place ECG strip in patient’s chart.
EVALUATION
Document in patient progress notes:
 Date and Time of 12 Lead ECG
 Interpretation of finding

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ECG Placement - for proper electrode adhesion

8. Check that the ECG monitor is plugged in or

ASSESSMENT a. Right arm – red color, labeled RA

14. Attach the correct lead wire to each

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