IDENTIFICATION AND RESOLUTION OF ARTIFACTS

The most common reasons for artifacts on an EKG that come from the patient involve body movement
or substances on the skin. Causes unrelated to the patient include mechanical issues and electrical
factors. EKG machines typically have filters that remove external interference. The usual setting is
40 hertz (Hz), which helps reduce any artifact from muscle tremors or any slight movement the patient
makes. Check to make sure that the filter is on. For patients who have a pacemaker, you might have to
adjust the filter to make sure the pacemaker spikes are visible on the EKG. The filter removes artifacts
that would otherwise appear on EKG paper. It does not affect electronic interpretation of the EKG.

Challenge Which of the following are the most common causes of patient-

related artifacts on an EKG tracing? (Select all that apply.)
A. Movement B. Mechanical factors C. Substances on the skin D. Electrical factors
A and C are correct. The most common reasons for artifact on an EKG that come from
the patient involve body movement or substances on the skin.

Wandering baseline
The baseline is the time between each cardiac cycle and appears as a flat line. It is
a time of repolarization, or relaxation. Improper placement of the electrodes can
cause this. In a wandering baseline, the recording has wavelike up-and-down
movements throughout the tracing. This artifact can result from a variety of
causes.

⦁⦁ Movement of the cables or ⦁⦁ Dry electrodes

leads during the procedure
⦁⦁ Labored breathing
⦁⦁ Patient movement
⦁⦁ Improper skin preparation
⦁⦁ Loose electrodes (leaving traces of lotion, oils,
or gel on the skin)

An easy way to eliminate the wandering baseline is to reposition the limb leads and make sure they
are on fleshy areas. To avoid many of the wandering baseline issues:
repolarization. Relaxation
⦁⦁ Instruct the patient to make sure the skin is free of topical substances. of the heart muscle in
its resting state.
⦁⦁ Clean attachment sites prior to the procedure.
⦁⦁ Educate the patient on what to expect.

⦁⦁ Provide clear directions on how to breathe and when not to talk.

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Somatic tremor
Muscle movement on an EKG tracing is a somatic tremor. It appears as uneven
spikes on the EKG tracing. These spikes are erratic because the electrical voltage
that controls muscle movement is not consistent, like cardiac voltage is. Multiple
factors cause somatic tremor, some of which are controllable (such as shivering)
and others that are not (such as active seizure activity).

Offering a light blanket and maintaining a warm temperature in the room

helps reduce shivering. Patients who are anxious often have muscular
movement. A thorough explanation of the procedure might help reduce this
movement. Encouraging the patient to take deep, slow breaths might also help. Patients who have
medical disorders such as Parkinson’s disease are prone to uncontrollable muscle movement. Placing Parkinson’s disease. A
the palms in a prone position and under the buttocks or crossed over the abdomen might help. Do progressive, degenerative
not perform an EKG while a patient is having an active seizure unless the provider directs you to do central nervous system disorder
so. that causes constant muscle
spasms and shakiness.

Alternating current (AC) interference

Any electronic device on the patient or near the patient has the potential to
cause electrical interference—especially a cell phone. Even electrical wires
in the walls, ceiling, and floor can cause AC interference, as can medical
equipment nearby. This type of artifact creates uniform small spikes on the
EKG tracing. Be sure cell phones are off and move them away from patients
during the procedure. Also, pull the examination table away from the wall.
Check that the ground prong of the three-prong plug is tight and fits snugly in
the outlet. Medical devices such as insulin pumps can interfere with the EKG
tracing, but they have to remain with the patient. Many EKG machines operate
on battery power, so if you cannot find and correct the cause of AC interference,
try unplugging the EKG machine and see if you can get a better tracing on battery power.

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Interrupted baseline
A baseline that is not continuous sometimes indicates an interruption
in the electrical connection. The stylus on the paper might move very
strongly up and down or it might create a flat line at the bottom or
the top of the EKG paper. It could result from patient movement that
dislodges an electrode. It could also be the result of a lead wire that
broke or has come loose from the electrode. Regular observation and
maintenance of the lead wires as well as double-checking connections
prior to starting the EKG can help prevent this issue.

National Healthcareer Association Certified Patient Care Technician (CPCT) Certification Study Guide Focused Review