ELECTROCARDIOGRAM (ECG)

Electrocardiogram or electrocardiograph is a diagnostic tool used in assessing the

cardiovascular system. It is a graphic recording of the electrical activity of the heart.

TYPES OF ECG
1. 12 Lead ECG (12LECG)
Commonly used to diagnose myocardial ischemia or infarction, high or low
calcium and potassium levels and effects of some medications.
2. 15 Lead ECG
Three (3) additional chest leads across the precordium and is a valuable tool
for the early diagnosis of the Right ventricular and posterior left ventricular
infarction.
3. 18 Lead ECG
early detection of myocardial ischemia and injury

WAYS TO OBTAIN AN ECG

1. Standard 12 Lead ECG
V1 > 4th intercostals space, right sternal border (Red)
V2 > 4th intercostals space, Left sternal border (yellow)
V3 > diagonally between V2 and V4 (green)
V4 > 5th intercostal space left mid-clavicular line (brown)
V5 > same level as V4 anterior axillary line (black)
V6 > same level as V4 and V5 mid-axillary line (violet)
2. Hardwire Monitoring
3-5 electrodes ( cardiac monitor)
3. Telemetry
Small box that the patient carries and continuously transmits ECG
information by radio waves to a central monitor elsewhere ( wireless)
4. Holter Monitor
10-24 hours
small, lightweight tape recorder like machine, continuously records the ECG
on a tape which is later viewed and analyzed with a scanner

5. Trans-telephonic Monitoring
The patient attaches a specific lead system for transmitting the signal and
places a telephone mouth piece over the transmitter box: The ECG is
recorded and evaluated at another location.

ELECTROCARDIOGRAM LEAD
PLACEMENT
A. Limb electrode placement
LA
RA
RL
LL

Left Arm
Right Arm
Right leg
Left Leg

LA
RA
RL
LL

B.Standard 12 Lead ECG Placement

C. 15 Lead ECG Placement

Yellow
Red
Black
Green

D. 18 LEAD ECG PLACEMENT

ECG PAPER

(Indicate the Name, age and the initial BP of the patient in the lower part of the ECG paper)

CARDIAC MONITOR

PROCEDURES:
1. Verify the order for the ECG in the client's chart.
2. Confirm the client's ID by checking two client identifiers according to your
facility's policy.
3. Provide privacy and explain the procedure to the client. Explain that the test
records the heart's electrical activity and that it may be repeated at certain
intervals. Emphasize that no electrical current will enter the body. Tell the
client that the test typically takes about 5 minutes.
4. Wash your hands.
5. Place the ECG machine close to the client's bed and plug the cord into the
wall outlet or, battery-operated, ensure that it is functioning. Turn on the
machine and input required client information. If the client is already
connected to a cardiac monitor, move the electrodes to accommodate the
precordial leads.
6. Have the client lie supine in the center of the bed with arms at his sides.
You may raise the head of the bed to promote comfort. Expose the arms and
legs and cover the client appropriately. The arms and legs should be relaxed
to minimize muscle trembling, which can cause electrical interference.
7. If the bed is too narrow, place the client's hands under his buttocks.
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 electrode at each electrode
position. If your client is a woman, be sure to place the chest electrodes below
the breast tissue. In a large-breasted woman, you may need to displace the
breast tissue laterally.
12. Connect the lead wires to the electrodes. The tip of each lead wire is
lettered and color-coded for easy identification. The white or RA lead wire
goes to the right arm; the green or RL lead wire, to the right leg; the red or LL
lead wire, to the left leg; the black or LA lead wire, to the left arm; and the
brown or V1 to V6 lead wires, to the chest electrodes.
13. Check to see that the paper speed selector is set to the standard 25
mm/second and that the machine is set to full voltage. The machine will
record a normal standardization marka square that is the height of two large
squares or 10 small squares on the recording paper.
14. Ask the client to relax and breathe normally. 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. Ensure the bed is in a low
position.
18. Remove any remaining equipment and wash 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.
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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.
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.