Doing an ECG

Patient Position/Preparation

  • Introduce yourself and wash hands
  • Check/document patient details
  • Explain and gain consent
  • Make sure patient is comfortable, lying at 30-40 degrees with one or two pillows supporting the head
    • If any other position- document this in the notes
  • try and get the patient to remain still and relax
  • Enter patient ID and details into machine
  • Attach limb and chest electrodes
    • shaving/cleaning the skin may be required
    • apply over bone and not muscle to limit interference

Electrode Placement

  • Limb leads
    • Red electrode– Right arm
    • Yellow electrode- Left arm
    • Black electrode (neutral)- Right leg
    • Green electrode- Left leg
  • Chest leads
    • V1- 4th IC space, right sternal edge
    • V2- 4th IC space, left sternal edge
    • V3- in between V2 and V4
    • V4- 5th IC space, midclavicular line
    • V5- same level as V4, anterior axillary line
    • V6- same level as V4/5, mid-axillary line
  • NB in females the bra should be removed and the electrodes should be places under the breast tissue where appropriate

Common problems with ECG/interference patterns

  • AC interference from nearby electrical equipment can produce a very high frequency interference pattern affecting the whole trace
  • Muscle tremor (more commonly detected than actually present) often will produce a jagged baseline, making it hard to determine P/T wave activity
  • Baseline wander can be due to breathing patterns or other movements.



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