Clinical skills: conducting an ECG

Question 1

Should you explain all steps to the patient/obtain consent as you go?

Answer 1

YES

Question 2

How should you introduce yourself to the patient?

Answer 2

7 steps
Explain purpose and procedure - going to put some ECG dots on your chest, wrist, ankles; these will send a message to recorder which will create a graph which shows how your heart is working. There is absolutely no danger and you will feel no pain.

Question 3

What two additional questions should you ask the patient?

Answer 3

Are you allergic to anything?
Are you taking any medications at the moment?

Question 4

How to get correct patient position/exposure?

Answer 4

Get them lying down with head on pillow, hands by side
Ask them to remove their shirt and bra.
Offer privacy - gown/sheet, curtains

Question 5

How do you prepare the skin?

Answer 5

Wipe if oily or dirty
May need to clip if hairy.

Question 6

Placing the chest electrodes
- How to obtain patient consent?
- Where to place the chest electrodes?
- Which way should the tabs of the electrodes point?

Answer 6

I’m going to put the ECG dots on your chest. Is it okay if I feel your chest to work out where they go?

V1 and V2: 4th intercostal space, either side of the sternum.
V3: between V2 and V4
V4: 5th intecostal space, mid clavicular line.
V5: left anterior axillary line, horizontal to V4
V6: left mid axillary line, horizontal to V5

Question 7

Placing arm and leg electrodes
- Where should they go?
- Which ways should the tabs point?

Answer 7

Inner surfaces of wrists/just above ankles
Down for arms, up for legs

Question 8

Placing arm and leg electrodes
- If there are complications (eg. leg ulcerations), can you move the electrodes up the limb?
- In extreme situations (eg. amputee) - can you put two leg electrodes on one leg, and two arm electrodeson one arm?

Answer 8

Yes
You can have two leg electrodes on one leg, but NEVER two arm electrodes on one arm

Question 9

What are the next few steps?

Answer 9

• Attach leads (ensure they are correct)
• Record the ECG - get patient to stay still while recording
• Remove leads and electrodes - offer patient to remove it themselves

Question 10

Documentation
- What demographic information should you write on the ECG?

Answer 10

Name
Age
Gender
Chest pain at time of ECG (from 0-10)
If the patient is taking digoxin

Question 11

What should you do next?

Answer 11

Review the ECG - give to clinical educator/ensure it’s reviewed by experienced staff

Question 12

How to finish the procedure

Answer 12

Say you’ll show to clinical supervisor
Any questions?
Thanks for your time.

Question 13

How to finish the procedure

Answer 13

Say you’ll show to clinical supervisor
Any questions?
Thanks for your time.