ECG (Electrocardiography)

The electrocardiogram (ECG) is a representation of

the electrical events of the cardiac cycle.
One of the most valuable frequently used diagnostic
tool.
Electrocardiography displays hearts electrical activity
as aveforms.
The !" lead ECG uses a series of electrodes placed
on e#tremities and the chest all to assess the heart
from !" different vies
The !" leads consist of$
Three %tandard limb or bipolar leads (&' &&' &&&)
utili(e three electrodes) these leads form a
triangle *non as Einthoven+s Triangle.
Three ,ugmented unipolar leads (a-.' a-/'
a-0).
%i# 1recordial unipolar leads (-!' -"' -2' -3'
-4' -5).
Suctioning
&ndicated for patients ith any of the folloing$
-isible presence of secretions in tube orifice
Coarse tubular breath sounds on auscultation in patient
unable to cough or ithout artificial airay in place.
1atient ith an artificial airay.
6efore procedure$
Chec* chart for doctors order indicating suctioning for
pt.
,ttach connective tubing to suction regulator7equipment
and inlet of suction container. Connect suction machine
to vacuum all outlet. Turn vacuum on' and occlude tip
of connective tubing.
&nform the patient7family of the procedure and its
purpose. 6e prepared to anser any questions about
the procedure that the patient may have.
8edical hand ashing before procedure and patient
handling should be done.
Equipment: ECG 8achine' .ecording 1aper' Electrodes
Conduction gel (Optional)' Clippers' ,lcohol sab or pad
Limb placement: Connect the lead ires to the electrodes.
The tip of each lead ire is lettered and color coded for
easy identification. The red or ., lead ire goes to the
right arm. The yellow or /, lead ire goes to left arm. The
black or 97 ./ lead ire goes to right leg. The green or //
lead ire goes to left leg.
Chest lead placement:
-! :::: .ed lead' 3th &ntercostal space to the right
of the sternum
-" :::: ;ello /ead' 3th &ntercostal space to the
left of the sternum
-2 :::: Green /ead' miday beteen -" and -3
-3 :::: 6ron lead' 4th &ntercostal space at the
midclavicular line
-4 :::: 6lac* lead' anterior a#illary line at the
same level as -3
-5 :::: -iolet lead' mida#illary line at the same
level as -3 and -4
Wash hands and apply personal protective equipment as
indicated.
Adjust vacuum between -80 to -120mmH !or adults or -"0
to -80mmHq !or pediatrics.
#osition the patient by e$tendin the nec% slihtly to
!acilitate entrance into the trachea &especially !or
nasotracheal auctionin'.
(pen suction catheter e$posin only the connector) attach
to connective tubin and maintain sterility o! catheter.
*ill sterile bo$ with sterile water) and place a dab o! water-
soluble lubricant on sterile envelope i! nasotracheal
suctionin is to be per!ormed.
+hec% heart rate be!ore) durin and a!ter procedure. ,!
tachycardia or bradycardia occurs discontinue the
procedure until it resolves.
#lace sterile loves on both hands.
-emove suction catheter !rom envelope maintainin
sterile technique. .(/01 coat tip o! catheter with lubricant
only i! nasotracheal suctionin is to be per!ormed.
6efore procedure' remove metals' coins' <eelries and
dentures from patients body.
E#plain procedure to client. 1rovide client privacy.
,s* the patient to lie still and not to tal* and to breathe
normally and rela# hen recording ECG.
8achines have a display screen so that you can
previe aveforms before the machine records them
on paper.
1ress the 1.&9T button. Observe the tracing quality.
The machine ill record all !" leads automatically'
recording three consecutive leads simultaneously.
=hen the machine finishes recording the !":lead
ECG' remove the electrodes and clean the client+s
s*in.
,fter disconnecting the lead ires from the electrodes
cleanse the electrodes as per manufacturers
instruction. /eave to dry.
,ssist the client to a comfortable position. Ensure the
bed is in a lo position.
.emove any remaining equipment and ash your
hands.
>ocument the procedure in 9urses notes.
,! patient has an arti!icial airway in place) hypero$yenate with
a resuscitation ba or mechanical ventilator. ,! patient is
receivin o$yen therapy) request several deep breaths be!ore
suctionin.
,nsert the catheter throuh the nose or endotracheal tube to the
point o! restriction without applyin suction. .(/01 do not
aressively !orce the tip o! the catheter throuh any
obstructions in the nose. Withdraw the catheter and reposition
the patient2s head and try aain.
A!ter the restriction has been passed) slowly advance catheter.
As% patient to ta%e deep breaths or watch !or inspiration. #ass
catheter into trachea.
(nce catheter has been placed in trachea) slowly withdraw
while applyin intermittent suction and rotatin catheter.
-emember1 3uction should not be applied !or more than 10-14
seconds.
Hypero$yenate the intubated patient or request the non-
intubated patient to ta%e several deep breaths.
Auscultate the patient2s chest5 i! secretions can still be heard
repeat the suctionin procedure &4-10ml o! normal saline may
be used to loosen tenacious secretions'. 6e!ore re-suctionin)
clear catheter with sterile water.