CENTRO ESCOLAR UNIVERSITY

Malolos

SKILLS LABORATORY PERFORMANCE CHECKLIST

LEAD ECG AND INTERPRETATION

Criteria 5 4 3 2 1
ASSESSMENT
1 . Assess chest pain and its relationship to ECG changes.
2 . Identify patient’s previous cardiac history.
Assess for signs and symptoms of fear and anxiety related to the procedure
3 . that may affect cardiopulmonary status of the patient.
PLANNING
1. Assemble and identify all the equipments:
1.1. Electrodes
1.2. Electrode gel
1.3. ECG machine
1.4. ECG paper
1.5. Alcohol wipes
1.6. Razor
1.7. 4x4 gauze pad
1.8. Calipers for reading
1. Assemble and identify all the equipments:
1.1. Electrodes
1.2. Electrode gel
1.3. ECG machine
1.4. ECG paper
1.5. Alcohol wipes
1.6. Razor
1.7. 4x4 gauze pad
1.8. Calipers for reading
1 .
IMPLEMENTATION
1 . Review patient's medical record, including physician's order.
Explain procedure to the patient.

b. For a male infant – retract foreskin and gently cleanse glans penis with a
cotton ball moistened with soap and
water.
2 .
Re-dress infant and holds infant for a period of time following the bath
3 . procedure.
4 . Wash hands
5 . Place the patient in a supine position
6 . Check and remove all metal objects.
Cleanse skin areas on the patient where the electrodes will be attached with
water or cotton balls with alcohol. Allows to dry or wipe with 4x4 gauze pad.
7 .
8 . Shave areas which are excessively hairy.
9 . Check that the ECG monitor is plugged in or turned ON.
10 . Attach cable to the monitor.
Limb Lead Application:
11.1. Positions the limb electrodes. Connects the lead wires. For easy visual
identification, each is color-coded and lettered.
11.1.1. Right arm lead wire is red, and labeled RA
11.1.2. Right leg lead wire is black, and labeled RL
11.1.3. Left leg lead wire is green, and labeled LL
11.1.4. Left arm lead wire is yellow, and labeled LA
11 .
Chest Lead Application:
12.1. Apply electrodes with electrodes gel to the chest. Avoid
positioning the electrodes directly on bone, which will cause interference. In
the female, position the electrodes below the breast tissue. If the breasts are
large, you may have to position the breast laterally.the axilla.

12 .
Palpate for the Angle of Louis, the notch between manubrium and body of
sternum, which is located in the 2nd rib. Continue palpating
downward to the fourth rib. Move down slightly to the space between the
fourth and fifth ribs.
13.1. Positions lead V1 in the fourth intercostals space, to the right of the
sternum.
13.2. Positions lead V2 directly opposite V1 at the left sternal border.
13.3. Positions lead V4 in the fifth intercostal space at the midclavicular line.
13.4. Positions lead V3 halfway between V2 and V4.
13.5. Positions leads V5 and V6 laterally to V4. Positions V5 in the anterior
axillary line. V6 is positioned in the midaxiary line.

13 .
After applying the electrodes, enter information required into the ECG cart.
Applying electrodes first allows the electrode gel to contact and penetrate the
skin surface.
14 .
 Criteria 5 4 3 2 1
15 . Attach the correct lead wire to each electrode.
Ensure that the following have been checked:
16.1.The machine is plugged in or that the battery has been fully charged
16.2. All leads are secured correctly, are clean and in good working order
16.3. There is paper in the device
16.4. Filter is used (to help rule out interference)
16.5. Ensure that speed is set to 25mm/sec
16.6. Ensure that calibration is set to 10mm/sec

16 .
If thermometer has disposable Ask the patient to lie still and breathe normally
and keep still.
17 .
Press the “AUTO” or “RECORD” button. Check the tracing quality. If artifact
is present, try to correct the problem. It may be necessary to use fresh
18 . electrodes. Run ECG strip.
Remove the lead wires and electrodes. Clean the electrode gel from the
19 . patient’s skin.
20 . Place patient in position of comfort.
21 . Clean the leads with an approved solution.
Wash Hands

b. For a male infant – retract foreskin and gently cleanse glans penis with a
cotton ball moistened with soap and
water.
22 .
Interpreting ECG strip:
23.1. Determine heart rate by calculating
(P-R interval). Normal pulse is 60-10 Heart rate is calculated by:
23.1.1. Counting the number of small boxes between R waves, and dividing
the number into 1500 or 300 divided by the big boxes. The quotient is the
ventricular heart rate
Interpreting ECG strip:
23.1. Determine heart rate by calculating (P-R interval). Normal pulse is 60-
10 Heart rate is calculated by:
23.1.1. Counting the number of small boxes between R waves, and dividing
the number into 1500 or 300 divided by the big boxes. The quotient is the
ventricular heart rate

23 .
Determine the regularity of rhythm. Checks if Complexes look alike and are
equally spaced by using calipers.
24 .
25 . Place ECG strip in patient’s chart.
EVALUATION
1.1 Document in patient progress notes:
1.2. Date and Time of 12 Lead ECG
1 . 1.3. Interpretation of findings
Total Score: ______
Comments/Suggestions:

Computation: Total Score divided by 30 (number of items) x 20 (factor) = __________________

Equivalent Numeric Grade: _______________