ELECTROCARDIOGRAPHY (ECG)

Definition

Electrocardiography (ECG) is the most commonly used test for evaluating cardiac
status, graphically records the electrical current (electrical potential) generated by the
heart. This current radiates from the heart in all directions and, on reaching the skin, is
measured by electrodes connected to an amplifier and strip chart recorder.

Purpose

 To perform electrocardiography according to the standard of care.

 To help identify primary conduction abnormalities, cardiac arrhythmias, cardiac
hypertrophy, pericarditis, electrolyte imbalances, myocardial ischemia, and the site
and extent of myocardial infarction.

 To monitor recovery from an MI.

 To evaluate the effectiveness of cardiac medication.
 To assess pacemaker performance
 To determine effectiveness of thrombolytic therapy and the resolution of ST-
segment depression or elevation and T-wave changes.

Assessment
 Assess the client's medical record for information regarding the need for an ECG.
 Assess the client's heart rate, heart sounds, and blood pressure.
 Assess the client's chest for areas of irritation, skin breakdown, or excessive hair
growth that may interfere with the electrode placement.

Equipment

 ECG machine
 Recording paper (ECG paper)
 Disposable pre-gelled electrodes
 4" × 4" gauze pads or washcloth

PROCEDURE AND RATIONALE

 PROCEDURE RATIONALE
1. Verify the order for the ECG in the  This ensures that the correct intervention
client's chart. is performed on the correct patient.

2. Gather all equipment and bring to Having equipment available saves time
bedside. and facilitates accomplishment of
procedure

3. Perform Hand hygiene and put on PPE Hand hygiene and PPE prevent the
if indicated spread of microorganisms. PPE is
required based on Transmission
precautions.

4. Identify the patient. Identifying the patient ensures the right

patient receives the intervention and
helps prevent errors. 

5. Provide Privacy and Explain the This ensures the patient’s privacy.
procedure. Ask the patient about allergies Explanation relieves anxiety and
to adhesive, as appropriate. facilitates cooperation. Possible allergies
may exist related to adhesive on ECG
leads.

6. Place the ECG machine close to the
patient’s bed and plug the power cord
into the wall outlet.
7. If the bed is adjustable, raise it to a
comfortable working height.
Having equipment available saves time
and facilitates accomplishment of task
Having the bed at the proper height
prevents back and muscle strain.

8. Have the patient lie supine in the
center of the bed with arms at the side.
Raise the head of the bed if necessary.
Expose the patient’s arms and legs.
Make sure the feet do not touch the bed’s
footboard
9. Select flat, fleshy areas on which to
place the electrodes. Avoid muscular and
bony areas. If the patient has amputated
limb, choose a site on the stump.
Proper positioning helps increase patient
comfort and will produce a better tracing.
Having the arms and legs relaxed
minimizes muscle trembling, which can
cause electrical interferences.
Tissue conducts the currents more
effectively than bone, producing better
tracing.
10. If the area is excessively hairy, clip
the hair. DO NOT SHAVE HAIR. Clean
excess oil or other substances from the
skin with soap and water and dry it
completely.
11. Apply the limb lead electrodes.
Position disposable electrodes on the
legs with the lead connection pointing
superiorly.
12. Connect the limb lead wires to the
electrodes. Make sure the metal parts of
the electrodes are clean.
13. Expose the patient’s chest. Apply the
precordial lead electrodes. Peel the
contact paper of the self-sticking,
disposable electrode and apply directly to
site.
14. Enter the appropriate Patient data
into the machine
15. Ask the patient to relax and breathe
normally. Instruct the patient to lie still
and not to talk while you are recording
the ECG.
16. Press the AUTO button. Observe the
tracing quality.
17. When the machine finishes recording
the 12- lead ECG, remove the electrodes
and clean the patient’s skin, if necessary,
with adhesive remover for sticky residue.
Shaving causes micro abrasion on the
chest skin. Oil and excess hair interfere
with electrode contact and function.
Alcohol, benzoin, and antiperspirants are
not recommended to prepare skin,
Having the lead connection pointing
superiorly guarantees the best connection
to the lead wire.
Dirty or corroded electrodes prevent a
good electrical connection
Proper lead placement is necessary for
accurate tests results.
This allows for proper identification of the
ECG strip.
Lying still and not talking produces a
better tracing.
Observation of tracing quality allow
adjustments to be made if necessary.
Removal and cleaning promote patient
comfort
18. After disconnecting the lead wires
from the electrodes, dispose the
electrodes appropriately.
19. Return the patient to a comfortable
position. Lower bed height and adjust the
head of the bed to a comfortable position.
20. Document in your notes the test's
date and time and significant responses
by the client. Verify the date, time, client's
name, and assigned ID number on the
ECG itself. Note any appropriate clinical
information on the ECG.
21.Clean ECG machine per facility policy.
22. Remove additional PPE, if used.
Perform hand hygiene.
LIMB LEAD PLACEMENT
Proper disposal deters the spread of
microorganisms.
Positioning with head adjustment
promotes patient comfort. Lowering the
bed height promotes patient safety
Accurate labeling ensures the ECG is
recorded for the correct patient.
Cleaning equipment between patient
uses decreases risk for transmission of
microorganism.
Removing PPE properly reduces the risk
of infection transmission and
contamination of the other item, Hand
hygiene prevents transmission of
microorganism
ELECTRODE PLACEMENT:
To ensure accurate test results, position chest electrodes as follows:

V1: Fourth intercostal space at right

border of sternum V4 : Fifth intercostal space at
midclavicular line
V2 : Fourth intercostal space at left
border of sternum V5 : Fifth intercostal space at anterior
axillary line (halfway between V4 and V6
V3 : Halfway between V2 and V4 )
V6 : Fifth intercostal space at midaxillary
line, level with V4
Lifespan Considerations

Infant/Child

 When obtaining a pediatric ECG enlist the help of the parents, if possible,
try distracting the child to keep them still during the tracing. If artifact from
either the arm or leg is a problem, try moving the lead to a more proximal
position on the extremity.
Older Adult

 In older adults, remove the electrodes carefully to prevent tearing of the

skin, as adults grow older the skin becomes thinner and tears easily.

Special Considerations

 Small areas of hair on the client's chest or extremities may be clipped; clipping
usually is not necessary.
 If the client's skin is exceptionally oily, scaly, or diaphoretic, rub the electrode site
with a dry 4" × 4" gauze pad or washcloth before applying the electrode to help
reduce interference in the tracing. During the procedure, ask the client to breathe
normally. If the respirations distort the recording, ask the client to hold his breath
briefly to reduce baseline wander in the tracing.
 If the client has a pacemaker, you can perform an ECG with or without a magnet,
according to the physician's orders. Be sure to note the presence of a pacemaker
and the use of a magnet on the strip.
 If the patient is an amputee, apply the electrode to the stump.
 It is usual to note whether the patient hast chest pain or is pain free at the time of
the ECG recording. In some hospitals it is policy for the person recording the
ECG to date and sign the printout.