How to do an ECG

Question 1

Steps required to prepare the patient before an ECG?

Answer 1

1) check and document patient’s details
2) explain procedure + gain verbal consent
3) ensure pt comfortable, lying on bed at 30-40 degrees with one/ two pillows supporting the neck (if pt is in any other position e.g. chair then document this)
4) ensure the room is warm and free from draughts
5) encourage pt to relax

Question 2

How to set up for an ECG?

Answer 2

1) confirm pt ID and enter into the machine
2) attach limb and chest electrodes ensuring they are accurately positioned and applied
3) check the machine is at the correct settings
4) ask pt to lie still and relax while the recording is taken
5) ensure good quality recording is obtained, disconnect leads and clean the electrode site

Question 3

How to confirm patient ID?

Answer 3

• ask pt to confirm their ID and verify against their wrist band
• ensure the correct pt details are entered into the ECG machine

Question 4

How should the skin be prepared for an ECG?

Answer 4

• lightly rub skin with dry gauze to remove loose dry skin
• if needed shave the skin to improve electrode contact and make removal painless
• if needed clean the skin from body oil/ creams then dry the area before applying electrodes

Question 5

should electrodes be applied over bone or muscle?

Answer 5

apply over bone to limit interference

Question 6

where should the limb electrodes be placed?

Answer 6

ideally arm electrodes at the wrist and limb electrodes at the ankles (right arm, left arm and left foot)

Question 7

where should the chest electrodes be placed?

Answer 7

V1 - 4th IC space, right sternal edge
V2 - 4th IC space, left sternal edge
V3 - between V2 and V4
V4- 5th IC space, midclavicular line 
V5 - 5th IC space, anterior axillary line
V6 - 5th IC space, midaxillary line

Question 8

Any special considerations when doing an ECG on a female?

Answer 8

• bra should be removed

- electrodes should usually be placed under the breast fold in the appropriate IC space

Question 9

what are tracing problems usually due to? name some common examples

Answer 9

usually due to poor electrode contact

e.g. AC interference, muscle tremor, baseline wander