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Electrocardiogram
Electrocardiogram
Substance
*The number and placement of the electrodes depend on the type of ECG needed
Types of ECG Recordings
• Bipolar leads record voltage between electrodes placed on wrists & legs (right
leg is ground) • Lead I records between right arm & left arm • Lead II: right arm &
left leg • Lead III: left arm & left leg
POSITIONING CHEST ELECTRODES To ensure accurate test results, position chest
electrodes as
follows:
An ECG machine A cardiac monitor A small box A small, lightweight tape-
recorder machine
Interpreting the ECG
ECG waveforms are printed on graph paper that is
divided by light and dark vertical and horizontal lines at standard intervals. TIME
and RATE: measured on the horizontal axis of the graph AMPLITUDE or VOLTAGE:
vertical axis POSITIVE deflection NEGATIVE deflection
WAVES. COMPLEXES, & INTERVALS
3 DISTINCT WAVES ARE PRODUCED DURING CARDIAC CYCLE
QT Interval
•
Measured from beginning of QRS to the end of the T wave = 0.32 to 0.40s in duration
(if 85 to 95 BPM) QT interval varies based on heart rate, gender, and age
PP interval
8. Select flat, fleshy areas to place the limb lead electrodes. Avoid muscular and
bony areas. If the client has an amputated limb, choose a site on the stump.
9. If an area is excessively hairy, clip it. Clean excess oil or other substances
from the skin with soap and water to enhance electrode contact.
10. Apply disposable electrodes to the client's wrists and to the medial aspects of
the ankles. Apply the pre-gelled electrode directly to the prepared site, as
recommended by the manufacturer's instructions. To guarantee the best connection to
the lead wire, position disposable electrodes on the legs with the lead connection
pointing superiorly.
11. Expose the client's chest. Put a pre-gelled
Tell the client to lie still and not to talk when you record the ECG. 15. Press
the AUTO button. Observe the tracing quality. The machine will record all 12 leads
automatically, recording three consecutive leads simultaneously. Some machines have
a display screen so that you can preview waveforms before the machine records them
on paper. If any part of the waveform height extends beyond the paper when you
record the ECG, adjust the normal standardization to half standardization. Note
this adjustment on the ECG strip because this change will need to be considered in
interpreting the results.
16. When the machine finishes recording the 12-
lead ECG, remove the electrodes and clean the client's skin. After disconnecting
the lead wires from the electrodes, dispose of the electrodes.
17. Assist the client to a comfortable position.
your hands.
19. 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.
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
HR:AR: depends on the u.r. ;VR: 100-200bpm RHYTHM: regular QRS SHAPE AND DURATION:
VENTRICULAR FIBRILLATION HR: greater than 300bpm RHYTHM: extremely irregular QRS
SHAPE AND DURATION: irregular IDIOVENTRICULAR RHYTHM HR:AR: 20-40 BPM RHYTHM:
regular QRS SHAPE AND DURATION: bizarre, abnormal shape, 0.12s or more VENTRICULAR
ASYSTOLE HR:AR: none RHYTHM: none QRS SHAPE AND DURATION: absent
1ST DEGREE AV BLOCK HR: depends on the underlying rhythm RHYTHM: depends on the
underlying rhythm QRS SHAPE AND DURATION: normal or abnormal P WAVE: regular shape
PR INTERVAL; greater than 0.20s, constant P: QRS RATIO: 1:1 2ND DEGREE AV BLOCK
TYPE 1 HR:AR: depends on the underlying rhythm RHYTHM: regular (PP interval) QRS
SHAPE AND DURATION: normal or abnormal P WAVE: depends on the underlying rhythm P:
QRS RATIO: 3:2, 4:3, 5:4
2ND DEGREE AV BLOCK TYPE II HR: depends on the underlying rhythm RHYTHM: depends on
the underlying rhythm QRS SHAPE AND DURATION: normal or abnormal P WAVE: depends on
the underlying rhythm PR INTERVAL; constant just before QRS P: QRS RATIO: 2:1, 3:1,
4:1 3RD DEGREE AV BLOCK HR:AR: depends on the underlying rhythm RHYTHM: regular (PP
& RR interval) QRS SHAPE AND DURATION: depends on the underlying rhythm P WAVE:
depends on the underlying rhythm P: QRS RATIO: more P waves than QRS complexes