POLICY

Policy Area: PULMONARY DEPARTMENT

Policy Title: ELECTROCARDIOGRAPHY PROCEDURE

Document Code: Revision No.:
AS-PUL-0002 1

Issue No.: Issue Date: Review Date: Page :

1 October 21,2021 October 21, 2024 1 of 4

Issued to:
NSO Department

1. RATIONALE AND POLICY STATEMENT

To define the responsibilities of Respiratory Therapists and Pulmonary Nurses
with validated competency to obtain an ECG recording.

2. RESPONSIBILITY
Respiratory Therapists and Pulmonary Nurses ensure correct placement of
Chest and Limb leads to obtain accurate ECG Reading.

3. ABBREVIATIONS
ECG - Electrocardiograph
RTOD - Respiratory Therapist on Duty
PNOD - Pulmonary Nurse on Duty
NOD - Nurse on Duty
HMO - Health Maintenance Organization
LOA - Letter of Approval
OPD - Outpatient Department
ER - Emergency Room

4. DEFINITIONS
Electrocardiography is the measurement of electrical activity in the heart and
the recording of such activity as virtual trace (on paper or on oscilloscope
screen), using electrodes placed on the screen of the limbs and chest.

5. SCOPE OF THE POLICY

ECG is done in OPD, ER and in Wards.

6. POLICY STEPS
6.1 OPD
Verify the doctor’s order to nurse on duty and obtain necessary details.
6.1.1 Do first handwashing and prepare the necessary materials and machine
that will use.
6.1.2 Receives request of patient and give a necessary form to fill out.
6.1.3 Issue the patient a charge slip
6.1.3.1 CASH BASIS
6.1.3.1.1 Patient will be given a charge slip and will pay the required amount
to the cashier.
6.1.3.1.2 Obtain the Official Receipt to the patient.
6.1.3.2 HMO BASIS
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6.1.3.2.1 Patient will present the LOA to RTOD/PNOD then issue a charge slip
and attached it to LOA.
6.1.4 Prepare the room and machine.
6.1.5 Introduce yourself and verify the patient’s name and date of birth.
6.1.6 Ask the patient to remove clothing from the waist up and don a hospital
gown with the opening to the front. Ensure privacy by closing the curtain and
door.
6.1.7 Explain the ECG procedures and answer questions, as appropriate, the
subject may have questions regarding the ECG.
6.1.8 Ask the subject to lay flat on the exam table with legs uncrossed and arms
to the side.
6.1.9 Wash or sanitize your hands and stand either on the left or right side of
the patient. Prepare the skin, where the electrodes will be placed, by rubbing
the lower legs, lower forearms, and chest area with alcohol swabs. Dry the
areas with gauze pads.
6.1.10 Apply the electrodes starting with the lower legs, lower forearms, and
chest area.
6.1.11 Turn on the machine and enter the subject’s name, date of birth, subject
ID number or other protocol specific information.
6.1.12 Ask the patient to breathe normally, relax, and remain still.
6.1.13 Acquire the ECG reading. Refer to the manufacturer’s operational
instructions for each specific machine.
6.1.14 When a satisfactory ECG is acquired, save, and print. Additional copies
for the ECG tracing are needed.
6.1.15 Remove lead wires and electrodes from the subject. Adhesive swabs or
a warm, moist wash cloth may be used to remove adhesive gel from the skin.
6.1.16 Hand washing is a must after the procedure is done.
6.1.17 Patient will be given a claim stub for the official results. Turnaround time
of results is 1-2 working days.
6.2 IN-PATIENT AND ER
6.2.1 Print the charge slip requested by the NOD
6.2.2 If the request is thru phone make sure to verify it to the NOD.
6.2.3 Prepare the Machine.
6.2.4 Enter the room of the patient and greet and introduce yourself and verify
the patient’s name and date of birth. Subject identifiers must match the in their
chart.
6.2.5 Ask the patient to remove clothing from the waist up and don a hospital
gown with the opening to the front. Ensure privacy by closing the curtain and
door.
6.2.6 Explain the ECG procedures and answer questions, as appropriate, the
subject may have regarding the ECG.
6.2.7 Ask the subject to lay flat on the exam table with legs uncrossed and arms
to the side.
6.2.8 Wash or sanitize your hands and stand either on the left or right side of
the patient. Prepare the skin, where the electrodes will be placed, by rubbing
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Policy Title: ELECTROCARDIOGRAPHY PROCEDURE
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the lower legs, lower forearms, and chest area with alcohol swabs. Dry the
areas with gauze pads.
6.2.9 Apply the electrodes starting with the lower legs, lower forearms, and
chest area.
6.2.10 Turn on the machine and enter the subject’s name, date of birth, subject
ID number or other protocol specific information. Verify information against the
chart.
6.2.11 Ask the subject to breathe normally, relax, and remain still.
6.2.12 Acquire the ECG reading. Refer to the manufacturer’s operational
instructions for each specific machine.
6.2.13 When a satisfactory ECG is acquired, save, and print. Additional copies
for the ECG tracing are needed.
6.2.14 Remove lead wires and electrodes from the subject. Adhesive swabs or
a warm, moist wash cloth may be used to remove adhesive gel from the skin.
6.2.15 Hand washing is a must after the procedure is done.
6.2.16 16 A copy of ECG tracings should be placed in the patient’s chart for
initial reading of Junior Consultant.
6.2.17 The official Results is 1-2 Days and will forwarded to NOD.
6.3 Electrode placement:
6.3.1 (RL) On the right leg, lateral calf muscle.
6.3.2 (LL) In the same location that RL was placed, but on the left leg.
6.3.3 (RA) On the right arm, avoiding thick muscle.
6.3.4 (LA) In the same location that RA was placed, but on the left arm.
6.3.5 (V1) In the fourth intercostal space (between ribs 4 & 5) just to the right
of the sternum (breastbone).
6.3.6 (V2) in the fourth intercostal space (between ribs 4 & 5) just to the left of
the sternum. (V3) Between leads V2 and V4.
6.3.7 (V4) In the fifth intercostal space (between ribs 5 & 6) in the mid-
clavicular line (the imaginary line that extends down from the midpoint of the
clavicle).
6.3.8 (V5) horizontally even with V4, but in the anterior axillary line. (The
anterior axillary line is the imaginary line that runs down from the point midway
between the middle of the clavicle and the lateral end of the clavicle; the lateral
end of the collarbone is the end closer to the arm.)
6.3.9 (V6) horizontally even with V4 and V5 in the midaxillary line. (The
midaxillary line is the imaginary line that extends down from the middle of the
subject's armpit.)
6.3.10 For pediatric patient, V1 and V2 will be removed and V3 and V4 will be
placed on the right side of the chest with same position and will be marked as
R3 and R4 then V6 will be moved at the lower part of the Axillary Line and
marked as V7.

7. REFERENCE/S:

7.1 https://www.saskatoonhealthregion.ca/about/NursingManual/1142.pdf
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7.2https://www.utmb.edu/policies_and_procedures/Non-IHOP/Respiratory/
Respiratory_Care_Services
7.3 https://ctsi.ucla.edu/researcher-resources/files/docs/sop-ecg-12lead-.pdf

8. ATTACHMENT/S:
Not Applicable

9. DEVELOPMENT TEAM:
9.1 Brian Abner Recio, RN

9.2 Mary Joy Sy, RN RMT

10. APPROVAL:
Prepared By: Reviewed By: Approved By:

Brian Abner Recio, RN Edward Jeremy Miranda Grace M. Aba

Pulmonary Unit Head Ancillary Serviced Director President & CEO

11. REVISION HISTORY:

(This part is being update whenever a revision was made.)
Revision No. Revision Description
Original Original Document, No revision/s has been made.

12. END OF DOCUMENT: