Electrode label (in the USA
On the right arm, avoiding thick muscle.
In the same location that RA was placed, but on the left arm.
On the right leg, lateral calf muscle
In the same location that RL was placed, but on the left leg.
In the fourth intercostal space (between ribs 4 & 5) just to the right of the sternum (breastbone).
In the fourth intercostal space (between ribs 4 & 5) just to the left of the sternum.
Between leads V2 and V4.
In the fifth intercostal space (between ribs 5 & 6) in the mid-clavicular line.
Horizontally even with V4, in the leftanterior axillary line.
Horizontally even with V4 and V5 in the midaxillary line.
Make sure that the electrodes are firmly attached. and remove the gel with a moist cloth towel. connect the lead wires. and on the chest. electrolyte imbalances. To monitor recovery from an MI. 2. If not. 5. 7. and wrists. thus reducing interference. All recording and other nearby electrical equipment should be properly grounded. leave the electrode patches in place. Reduce skin oil and debris by gently rubbing the skin with alcohol or some gauze. 3. Explain to the patient the need to lie still. 8. remove the electrodes. To evaluate the effectiveness of cardiac medication. 2.Purpose of Electrocardiography (ECG)
To help identify primary conduction abnormalities. Place the patient in a supine or semi-Fowler’s position. Press the START button and input any required information. 3. Place electrodes on the inner aspect of the wrists. and the site and extent ofmyocardial infarction. 4. To assess pacemaker performance To determine effectiveness of thrombolytic therapy and the resolution of ST-segment depression or elevation and T-wave changes. such as chest pain or pacemaker. and breathe normally during the procedure. After all electrodes are in place. determine which electrode has come loose. 2. 3. Note current cardiac drug therapy on the test request form as well as any other pertinent clinical information. Mild abrasion of the skin will reduce impedance between the skin and electrode. relax. If necessary. Expose the chest.
Electrocardiography (ECG) Procedure Patient Preparation for Electrocardiography (ECG) 1. Ensure the skin is dry. If the patient is having recurrent chest pain or if serial ECG’s are ordered. Explain that the test is painless and takes 5 to 10 minutes. carefully shave the chest to remove excess chest hair (always obtain patient consent first). 5.pericarditis. reattach it. Implementation 1. Disconnect the equipment. Nursing Interventions 1. this will help the ECG electrodes to adhere to the skin
. cardiac arrhythmias. on the medical aspect of the lower legs. 6. as this will help ensure better contact and also make it less uncomfortable for the patient when removing ECG electrodes. cardiac hypertrophy. ankles. 4. and restart the tracing. myocardial ischemia. Make sure that all leads are represented in the tracing.
In rare cases.6. Apply the ECG electrodes to the patient's chest following locally agreed protocols. Exercising or drinking cold water immediately before an ECG may cause false results. as some can interfere with test results. 11. Normal Values Heart rate: 60 to 100 beats per minute Heart rhythm: consistent and even
What abnormal results mean Abnormal ECG results may be a sign of Abnormal heart rhythms (arrhythmias) Cardiac muscle defect Congenital heart defect Coronary artery disease Ectopic heartbeat Enlargement of the heart Faster than normal heart rate (tachycardia)
. Check ECG electrodes. The electrodes may feel cold when first applied. Rectify any difficulties encountered. 2. 9. 10. 8. Switch the cardiac monitor on and select the required monitoring ECG lead. Ensure ECG trace is clear. They should not be allowed to pull on the ECG electrodes. not dry. No electricity is sent through the body. anchor the ECG cables. They should be in date and still moist. How the test will feel An ECG is painless. 7. Document in the patients notes that cardiac monitoring has commenced and the ECG rhythm identified.
How to prepare for the test 1. the electrodes should lie flat. Make sure your health care provider knows about all the medications you are taking. some people may develop a rash or irritation where the patches were placed.
arrhythmias. and reattached them if loose skin contact is suspended.
Heart valve disease Inflammation of the heart (myocarditis) Changes in the amount of electrolytes (chemicals in the blood) Past heart attack Present or impending heart attack Slower than normal heart rate (bradycardia)
What the risks are There are no risks. Abnormal Results 1. 3. so there is no risk of shock. right or left ventricular hypertrophy.12 second. 2. ischemia.12 to 0. right or left bundle-branch block.06 to 0. Make sure that the electrodes are firmly attached. QT interval that varies with the heart rate and lasts 0.
Interpretations Normal Results 1. Voltage of the R wave leads V1 through V6 that doesn’t exceed 27 mm.4 to 0.2 second for heart rates above 60 beats/min.5 mm (0. frayed. No electricity is sent through the body. 4. Abnormal wave forms during angina episodes or during exercise. Myocardial infarction (MI). or bare. conduction defects or pericarditis. and electrolyte abnormalities. Precautions
The recording equipment and other nearby electrical equipment should be properly grounded to prevent electrical interference. Total QRS complex lasting 0. P wave that doesn’t exceed 2. PR interval (includes the P wave plus the PR segment) persisting for 0. 5. 2.52 second for heart rates above 60 beats/min.
. Don’t use cables that are broken.1 second. Double-check color codes and lead markings to be sure connectors march.25 mV) in height or last longer than 0.
Improper lead placement.
Skin sensitivity to the electrodes.
Normal Sinus Rhythm
Junctional Escape Rhythm
Premature Junctional Complex
Premature Ventricular Complex (PVCs)
Monomorphic Ventricular Tachycardia (V-tach)
Polymorphic Ventricular Tachycardia (V-tach)
Torsades de Pontes
Coarse Ventricular Fibrillation (V-fib)
Fine Ventricular Fibrillation (V-fib)
1st Degree AV Block
2nd Degree AV Block type 1 (Mobitz I / Wenkebock)
3rd Degree AV Block (AV Dissociation)
Agonal Rhythm (Near Death or Swirling the Drain)
Pulseless Electrical Activity (PEA)