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HOSPITAL SHARED SERVICES

IPM Procedure for Electrocardiographs (Major)
Last Revised: March 28, 1991
Author: HOSPITAL SHARED SERVICES

Major:
Minor:

Interval
12 months

Time Required
0.8 Hours
Hours

DESCRIPTION
HSS PRODURE #:

B-1050

APPLICABLE TO:

Electrocardiographs [11-407]
Electrocardiographs, Multi-Channel [11-411]
Electrocardiographs, Single-Channel [11-413]

ALSO CALLED: EKG units, ECG units, EKG machines
COMMONLY USED IN: Electrocardiography departments, most patient care areas
SCOPE: Applies to single- and multi-channel electrocardiographs typically used for recording an
electrocardiogram on paper; may also be adapted for some systems that digitally store data and later
provide hard-copy tracings; not suitable for verifying performance of automated diagnostic
functions; does not apply to strip-chart recorders or direct writers, which should be inspected with
the ECG monitor or the defibrillator/monitor they are used in conjunction with (use the ECG
Monitors procedure and the Defibrillator/Monitors procedure, respectively)
SPECIAL PRECAUTIONS
Testing input isolation requires the use of a line voltage source. Although this source should include
a current-limiting resistor, use caution to avoid contact with any portions of the energized circuit.
TEST APPARATUS REQUIRED
G
G
G
G

Leakage Current Meter/Safety Analy
Ground Resistance Ohmmeter
ECG Simulator, Variable Output/Rate
Styluss Tension Gauge
SUPPLIES REQUIRED

G
G

Contact Cleaner
Lubricant Specified by Mfr

G

G Ruler, Metric, Transparent
Calipers,Drafting

Be sure to wire a new power cord or plug with the same polarity as the old one. ELECTRODES: Confirm that an adequate supply of electrodes is on hand. Attempt to wiggle the blades to determine that they are secure. that all assembly hardware is present and tight. Shake nonmolded plugs and listen for rattles that could indicate loose screws. If the device is protected by an external fuse. If it is attached to a wall or rests on a shelf. Leads and electrodes should be firmly gripped in their appropriate connectors. AC PLUG/RECEPTACLE: Examine the AC power plug for damage. CABLES: Inspect the cables and leads and their strain reliefs for general condition. Be sure that they hold the cord securely. CASTERS/BRAKES: If the device moves on casters. and verify that an adequate trace is received at each patient lead selection. check the security of this attachment.] Flex the patient cable near each end to verify that there are no intermittent faults. Also check line cords of battery chargers. If it is damaged. CIRCUIT BREAKER/FUSE: If the device has a switch-type circuit breaker. Examine cables carefully to detect breaks in the insulation and to ensure that they are gripped securely in the connectors of each end to prevent rotation or other strain. STRAIN RELIEFS: Examine the strain reliefs at both ends of the line cord. Electrical contact pins or surfaces should be straight and clean. If any damage is suspected. check that it moves freely. if the damage is near one end. Look for accumulations of lint and thread around the casters.IPM Procedure for Electrocardiographs (Major). open the plug and inspect it. [Checking all leads in some units will require either a 12-lead simulator or connection and disconnection of every lead. check its value and type against that marked on the chassis. check their condition. cut out the defective portion. MOUNT: If the device is mounted on a stand or a cart. and be sure that they turn and swivel. Check the operation of brakes and swivel locks. LINE CORD: Inspect the cord for signs of damage. replace the entire cord or. and that there are no signs of spilled liquids or other serious abuse. Connect the unit to an ECG simulator. and check the electrodes' physical condition. examine the condition of the mount. if the unit is so equipped. Page 2 QUALITATIVE TASKS CHASSIS/HOUSING: Examine the exterior of the unit for cleanliness and general physical condition. Be sure that plastic housings are intact. CONNECTORS: Examine all cable connectors for general condition. . and ensure that an appropriate spare is provided. as appropriate.

[Up to 10% spike or overshoot is acceptable but will usually not be observed in a unit that is functioning optimally (see Figure 1 in the ECRI IPM manual). 1 MV STEP RESPONSE: Depress and hold the 1 mV calibration button (or apply an external 1 mV pulse) for about 3 sec. pens). meters.] After 2 sec (50 mm of paper at a speed of 25 mm/sec). Be sure that all segments of a digital display function. as well as positive stopping. Check battery capacity by activating the battery-test function or measuring the output voltage. Check the condition of the battery charger and. if so equipped. verify that it is being performed on schedule. confirm the operation of all lights. indicators. ACCESSORIES: Verify that an adequate supply of electrodes and paper and a fuse are stored with the device or in the nursing unit for those electrocardiographs that remain in a fixed location. from fingernails. label it with the date. During the course of the inspection. Check that control knobs have not slipped on their shafts. Where a control should operate against fixed-limit stops. check for proper alignment.. Perform the inspection with the unit on battery power or operate the unit on battery power for several minutes to check that the batteries are charged and can hold a charge. alarm limits at the ends of their range). check their positions. if readily accessible.g. Check membrane switches for membrane damage (e. Examine all controls and switches for physical condition. When it is necessary to replace a battery. Page 3 CONTROLS/SWITCHES: Before moving any controls and alarm limits. Check operation of battery-operated power-loss alarms. and visual displays on the unit and the charger. . BATTERY/CHARGER: Inspect the physical condition of batteries and battery connectors. secure mounting. LABELING: Check that all necessary placards. Some batteries require periodic deep discharges and recharging to maintain maximum battery capacity. confirm that it does. in fact. If this is recommended by the manufacturer. to the extent possible. consider the possibility of inappropriate clinical use or of incipient device failure. INDICATORS/DISPLAYS: During the course of the inspection. square-cornered leading edge that is neither rounded nor spiked. A spare patient cable and stylus (or pen) may be kept with units on crash carts. and correct motion. Record the settings of those controls that should be returned to their original positions following the inspection. the pulse should have decayed no more than half its original amplitude (see Figure 2 in the ECRI IPM manual). labels. a gain control at maximum.g. The trace should exhibit a sharp.. and instruction cards are present and legible. If any settings appear inordinate (e. charge the battery. check that each control and switch performs its proper function. if so equipped.IPM Procedure for Electrocardiographs (Major).

all rollers. Problems might be caused by the transport mechanism or by an excessively tightly wound roll of paper. unit prints a single formatted sheet for each electrocardiogram).. If a formatted output is used (i. paper guides. It should be possible to move the baseline from the lower to the upper border of the chart paper with the the vertical position control. G All portions of a simulated ECG waveform should be clearly visible. CALIBRATE DAMPING AND STYLUS: Calibrate damping and stylus.IPM Procedure for Electrocardiographs (Major). PAPER TRANSPORT: Verify that the paper moves smoothly and without hesitation at all paper speeds. and off. including on. G There should be no 60 Hz noise when the lead selector switch is set to the lead 0 or standard position and the chart motor is activated. QUANTITATIVE TASKS GROUNDING RESISTANCE: Using an ohmmeter. PREVENTIVE MAINTENANCE CLEAN EXTERIOR AND ACCESSORIES: Clean the exterior (including front panel controls). G The baseline should remain within 1 mm of its initial position upon pushing the reset control. CRITERION: #0. G If so equipped. verify that all alphanumerics and tracings appear in the correct location and that the paper starts and stops at the correct points. Use stylus gauge to check tension. standby. The paper should not drift sideways in the transport mechanism. except on those units where mechanical stops prevent such travel. Operate the device in all normal modes.5 Ω CHASSIS LEAKAGE CURRENT: Measure chassis leakage current to ground with the grounding conductor of plug-connected equipment temporarily opened. CRITERION: #100 µA . electrical safety analyzer. as required. measure and record the resistance between the grounding pin of the power cord and exposed (unpainted and not anodized) metal on the chassis. the operator-adjustable stylus heat control should function and should not need to be set near either extreme to obtain a satisfactory setting. as needed. and record the maximum leakage current. Page 4 TRACE QUALITY: Observe the tracing with the unit in the standard lead select position (no input) and in lead I with a simulated ECG signal applied. it should be horizontal and not drift vertically.e. including the P wave and QRS. LUBRICATE RECORDER AND PAPER DRIVE: Lubricate the recorder mechanism and the paper drive per the manufacturer's specifications. Verify compliance with the following criteria: G The baseline should have constant thickness. or multimeter with good resolution of fractional ohms. and knife edges.

The speed should be accurate to within 2%. Because of the difficulty in resolving small errors..5 mm LINEARITY: Apply a calibrated 2 mV input to the writer. CRITERION: ±5% or 0. the trace should double in height (within 5%). R to R GAIN VS BASELINE POSITION: Vary the centering or position control to change baseline position. record a 1 mV pulse from the external reference generator and one from the internal 1 mV calibration signal of the writer. either from the internal calibrator or the reference generator.5mm Overshoot @ 2cm Pulse Height INSTO BALLANCE(BETWEEN LEADS): Many units have adjustment so that trace is blanked (signal is shorted) between leads. #0. CRITERION: Gain Variation. calibrated ECG simulator). and 20 mm/mV.g.000 msec (60 bpm on an ECG simulator). An ECG simulator can be used. It should be twice the deflection (within 5%) observed for a 1 mV signal.5mm @ 25mm/sec @ 60BPM. Page 5 CALIBRATION( GAIN ): This test determines the accuracy of the sensitivity control and of the internal 1 mV calibration signal and requires the use of an external source of known amplitude (e. If this calibration source is battery powered. Next. Deviation greater than this can often be corrected with the variable gain control (a screwdriver adjustment in many units). CRITERION: ±2% = 0. at sensitivity settings of 2.5 mm.#0. the tracing should be between 19 and 21 mm. at a chart speed of 50 mm/sec. CRITERION: ±5% PAPER SPEED: Use an ECG simulator set to 60 bpm or a signal or pulse generator set to 1 Hz that has been set or calibrated with a counter. If the interval between pulses is not within 10 msec at a pulse interval of 1.5. HIGH FREQUENCY(1MV PULSE) CRITERION: # 0. Check to verify that trace remains centered between leads. For an externally generated pulse of exactly 1 mV.5 mm. If the internally generated pulse and a 1 mV external pulse produce tracings of heights that differ by more than 0. The height of the calibration pulse should not vary more than 0. Using the internal calibration button. the internal calibrator is not within the recommended 5% accuracy.5 mm with baseline position. and a third with the baseline as close to the top margin of the paper as possible while still allowing the pulse to remain on the ruled chart. provided its amplitude is accurately known and appropriate corrections are made in interpreting the results. generate a pulse with the baseline set at the bottom margin of the chart. record 1 mV pulses. At a chart speed of 25 mm/sec and a pulse interval of 1. 5. investigate any deviation of more than 0.000 msec. Record the deflection at 10 mm/mV. the distance between the first and last of five successive peaks should be 100 ±2 mm. 10. even if its output is not precisely 1 or 2 mV. . the distance between the first and last of five successive peaks should be 200 ±4 mm. check its output with a precision voltmeter or similar instrument to confirm that the output is not affected by changing battery voltage.5 mm RETURN TO BASELINE POSITION: Check that trace returns to baseline after each cal pulse CRITERION: Variation. At each setting.IPM Procedure for Electrocardiographs (Major). another with the baseline at the middle of the chart.1 mm . an appropriate correction should be made in calculating paper speed.1/10th major division DAMPING. With sensitivity at 20 mm/mV.

IPM Procedure for Electrocardiographs (Major). use caution to avoid contact with any portions of the energized circuit. Metric.: Location: Control No: Manufacturer: Model: Serial: SPECIAL PRECAUTIONS Testing input isolation requires the use of a line voltage source. Variable Output/Rate G Styluss Tension Gauge SUPPLIES REQUIRED G G Contact Cleaner Lubricant Specified by Mfr G G Ruler. Drafting QUALITATIVE TASKS G G G G G G G G G Chassis/Housing Mount Casters/Brakes AC Plug/Receptacle Line Cord Strain Reliefs Circuit Breaker/Fuse Cables Connectors G G G G G G G G G Electrodes Controls/Switches Battery/Charger Indicators/Displays 1 mV Step Response Labeling Accessories Trace Quality Paper Transport PREVENTIVE MAINTENANCE G G Clean Exterior and Accessories Lubricate Recorder and Paper Drive G Calibrate Damping and Stylus . Although this source should include a current-limiting resistor. Transparent Calipers. Page 6 HOSPITAL SHARED SERVICES IPM Form for Electrocardiographs (Major)(B-1050) Work Order No. TEST APPARATUS REQUIRED G G G Leakage Current Meter/Safety Analy Ground Resistance Ohmmeter ECG Simulator.

5 mm Return to Baseline Position Variation.QUANTITATIVE TASKS Task Description/Criterion Set Indicd Measured Pass Fail T T Pass Fail T T Grounding Resistance #0.#0.: Task Description/Criterion Set Indicd Measured Calibration ( Gain ) ±5% or 0.1/10th major division Damping.1 mm .5 mm Linearity ±5% Paper Speed ±2% = 0. High Frequency(1mV pulse) # 0.5 Ω Chassis Leakage Current #100 µA Work Order No.: Control No. R to R Gain vs Baseline Position Gain Variation.5mm @ 25mm/sec @ 60BPM. #0.5mm Overshoot @ 2cm Pulse Height Insto Ballance(between leads) SUMMARY G Service Required Completed by: G Removed from Use Date IPM Time G Acceptable for Use Repair Time .