12-Lead ECG and Cardiac Monitor

Question 1

How do you initiate the procedure?

Answer 1

1. wash hands
2. introduce self, identify patient
3. explanation, rationale and consent - “today we’re going to be doing an ECG which involves attaching a number of sticky pads to your chest, arms and legs to which we will then attach a number of wires which will be attached to the ECG machine. This machine is used to look at how your heart is functioning (so we can properly assess these palpitations you’re having)” if relevant: “To do this properly we may have to shave some small patches of hair on your chest and legs”. “it shouldn’t be uncomfortable for you but if you are uncomfortable at any point, please let me know” - does this sound okay?
4. check for allergies - “do you know if you have any allergies to ECG stickers?”

Question 2

What is the relevant equipment?

Answer 2

1. ECG machine
2. Limb + chest leads
3. Disposable electrodes

Question 3

How do you perform the first part of the task?

Answer 3

1. draw curtains or close door
2. request patient remove clothing from upper half of body, females may keep bras on, trousers may be rolled up, long socks or tights should be removed
3. ensure patient lying comfortably
4. ensure skin is dry and not greasy, clean electrode site with alcohol swab, shave any hair if needed (to improve contact and reduce discomfort upon removal)
5. attach electrodes

Question 4

Where should electrodes be placed?

Answer 4

1. Limb leads - Red = right wrist, Yellow = left wrist, Green = left ankle, Black = Right ankle
2. Chest leads
   - to find - the first rib space is at the level of the sternal angle
   C1 = 4th intercostal space, right sternal border
   C2 = 4th intercostal space, left sternal border
   C3 = halfway between C2 and C4 (on the rib)
   C4 = 5th intercostal space, mid-clavicular line
   C5 = anterior axillary line and same horizontal level as C4
   C6 = mix-axillary line at the same horizontal level as C4 and C5

Question 5

How do you conduct the second half of the procedure?

Answer 5

1. ask the patient to relax and request them to refrain from moving and talking whilst the ECG is working (this is to reduce interference and improve the reading)
2. check the machine is set to AUTO (or check the speed is set at 25mm/sec and calibration is at 10mm/mv)
3. check all electrodes are in place and press start button on machine
4. commence ECG and obtain recording
5. check for artefacts and repeat if necessary
6. remove electrodes carefully, making sure patient is comfortable, check sites for any redness or itching
7. label ECG with patient name/deets, unit number, time and date of recording
8. record if there were any problems ie severe sweating, patient anxiety etc

Question 6

How do you conclude the procedure?

Answer 6

1. document in patients notes
2. ensure patient is comfortable, allow time to get dressed, thank patient
3. switch off machine
4. wash hands

Question 7

How do you set up a cardiac monitor?

Answer 7

1. same intro, prep of patient, allergies etc, consent them - “we’re going to be attaching 3 sticky pads to your shoulders and chest, attaching 3 leads to the sticky pads and attaching them to a machine which is going to monitor how your heart is functioning, does that sound okay?”
2. clean/shave skin etc
3. attach leads - Red=right shoulder, Yellow=left shoulder, Green=lower left chest wall, bottom of costal plane; smooth down adhesive not central gel disc (as can damage)
4. switch on monitor and select required monitoring lead (usually lead 3)
5. ensure trace is obtained and clearly displayed, check for abnormalities
6. check the alarms are set to safe parameters (follow hospital protocols)
7. secure leads so they will not tug on the electrodes and position the monitor so its visible
8. record in the notes that monitoring has commenced and what the start rhythm is
9. check patients welfare, check electrode sites regularly for redness/itching