LECTURER: SIR ROVIECH ECHEVERIA

BSN 4 | FIRST SEM | BATCH 2022 | TOPIC: TOPIC 3: ECG Monitoring Part 2
2. Place the ECG machine close to the patient’s
ECG MONITORING bed. Check the cable and wires for fleeing or
breakage and replaced them or obtain
another machine if necessary.
3. Plug the cord into the wall outlet or ensured
that the battery-operated ECG machine is
functioning properly. Turn on the machine.
Perform a self-testing according to the
manufacturers instruction and input the
required patient information.
Normal ECG Waveforms
§ Each lead takes a different view of heart
Let’s watch: The 12-Lead Placement
activity. (https://www.youtube.com/watch?v=--TZxs58j24)
§ It generates a characteristic tracing on an
ECG. 1. Greet Patient and introduce self.
§ The tracing shown here are a representative 2. Wash hands, check details, explanation.
of each of the 12 leads: 3. Chest Lead Placement:
o leads aVR and V1 through V4
normally show strong negative
deflections
- Negative deflections: current
is moving away from the
positive electrode
- Positive deflections: current is
moving towards the positive
electrode

EQUIPMENT
§ ECG machine with recording paper 4. Limb Lead Placement:
§ Disposable pre-gelled electrodes
§ Soap and water
§ Wash cloths
§ Bath blanket or sheet
§ Facility-approved disinfectant
§ Optional: disposable head hair clippers,
single-patient-use scissors, indelible marking
pen, gloves, alcohol pad, 4” × 4” (10-cm × 10-
cm) gauze pads

5. Place the disposable pre-gelled electrodes

Let’s now proceed to the equipment:
6. Place the leads on: Chest Leads.
1. Inspect all equipment and supplies. If a
7. Place the leads on: Limb Leads.
product is expired, defective or has a
§ Colors: Ride Your Green Bike
compromised integrity, remove it from the
o RIGHT UPPER LIMB
patients use. Label it as expired or defective
o LEFT UPER LIMB
and report the expiration or defect as
o LEFT LOWER LIMB
directed by your facility.
o RIGHT LOWER LIMB

NORSKSK 1

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 LECTURER: SIR ROVIECH ECHEVERIA
BSN 4 | FIRST SEM | BATCH 2022 | TOPIC: TOPIC 3: ECG Monitoring Part 2
17. Politely ask the patient to avoid moving or talking
8. Print the ECG result and place: during the ECG recording (to reduce electrical
§ Patient details artefact)
§ Date 18. Inspect trace quality
§ Signature 19. Print the trace
9. Remove leads. 20. Label the ECG with the patient’s details
21. Thank the patient
Let’s watch: How to record and ECG 22. Remove the leads and electrodes
(https://www.youtube.com/watch?v=1k4B_fIX_t0) 23. Wash hands

1. Wash hands NURSING CONDSIDERATIONS

2. Introduce yourself § During the procedure, instruct the patient to
3. Confirm patient details (Name & Date of Birth) breathe normally—to reduce baseline
4. Explain Procedure wander in the tracing.
5. Gain Consent o If the patient’s respiration distorts the
6. Position the patient at 45º ECG recording, instruct the patient to
7. Identify the 4th intercostal space hold their breath briefly.

§ If the patient has a pacemaker, you can

perform an ECG with or without a magnet
according to the practitioner's orders.
o Be sure to note the presence of a
pacemaker and the use of the
magnet on both the ECG strip and
the patients’ medical record

8. Attach V1 (Right 4th Intercostal Space) § Record the ECG with the patient in the same
9. Attach V2 (Left 4th Intercostal Space) position each time because different
10. Attach V4 (5th Intercostal Space Mid-Clavicular positions may cause differences in the
Line) tracings.
11. Attach V3 (Midway Between V2 & V4) o If another position is required
12. Attach V5 (Left Anterior Axillary Line at the level because of the patient's condition,
of V4)
document the position used on the
13. Attach V6 (Left Mid- Axillary Line) tracing and in the patient's medical
14. Attach an electrode to a bony prominence on record.
each upper limb (E.g. Ulnar Styloid Process)
15. Attach an electrode to a bony prominence on DOCUMENTATION
each lower limn (E.g. Medial Malleolus) § Date and time that the ECG was performed
16. Attach ECG leads to the electrodes (Chest § Any significant responses by the patient
Leads & Limb leads) § Verify the date, time, patient's name, and
§ RED LEAD 6 RIGHT ARM (Ulnar Styloid assigned identification number on the ECG
Process) itself.
§ YELLOW LEAD 6 LEFT ARM (Lemon = Left) o Note any appropriate clinical
§ GREEN LEAD = LEFT LEG information, positioning changes and
§ BLACK LEAD = RIGHT LEG calibration variations on the ECG

NORSKSK 2

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 LECTURER: SIR ROVIECH ECHEVERIA
BSN 4 | FIRST SEM | BATCH 2022 | TOPIC: TOPIC 3: ECG Monitoring Part 2
tracing and place it in the patient's
medical record
§ Document teaching provided to the patient
and family (if applicable), their
understanding of that teaching, and any
need for follow-up teaching.

COMPLICATIONS
Remember that improper ECG interpretation
techniques can lead to improper diagnosis and
treatment. So, it's very vital and a ground procedure
for us to have the correct diagnosis.

NORSKSK 3

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