11/13/24, 7\:26 PM Guide | Recording an ECG

Recording an ECG

Table of contents
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Gather equipment

Gather the appropriate equipment\:
ECG machine\: to record the ECG.
Self-adhesive ECG electrodes\: to attach the ECG leads to the patient.
Razor\: may be required to remove hair to provide adequate electrode contact with the skin.

Introduction

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Brie
t r a c e o f t h e h e a r t . T h e p r o c e d u r e w i l l i n v o l v e p l a c i n g s o m e s t i c k y p a d s o n t o y o u r c h e s t a n d l i m b s . I w i l l t h e n c o n n e c t t h e s e
s t i c k y p a d s t o t h e E C G m a c h i n e' s l e a d s t o r e c o r d t h e t r a c i n g .
"
If the patient is a female, explain the need for a chaperone\: " O n e o f t h e f e m a l e w a r d s t a
t h e p r o c e d u r e , a c t i n g a s a c h a p e r o n e , w o u l d t h a t b e o k ?"
Gain consent to proceed with ECG recording.
Adequately expose the patient's chest for the procedure (o
the patient's lower legs and wrists is also necessary to apply the limb leads.
https\://app.geekymedics.com/osce-guides/clinical-procedures/recording-an-ecg/ 1/411/13/24, 7\:26 PM Guide | Recording an ECG
Ask the patient to lay on the clinical examination couch with the head of the couch at a 45° angle.
Check if the patient has any pain before continuing with the clinical procedure.

Electrode placement

A 12-lead ECG involves the use of 10 electrodes, six on the chest and four on the limbs.
Begin by checking the expiry date of the electrodes to ensure they are within date.
It is important to ensure each electrode has good skin contact, which may involve cleaning or shaving the areas where you
need to place electrodes. If this is the case, make sure to explain this clearly to the patient and gain consent before
proceeding. See below for more details on how to improve skin contact with electrodes.

Chest electrode and lead placement (V1 - V6)

Apply the six chest electrodes in the following locations\:
V1\: 4th intercostal space at the right sternal edge.
V2\: 4th intercostal space at the left sternal edge.
V3\: midway between the V2 and V4 electrodes.
V4\: 5th intercostal space in the midclavicular line.
V5\: left anterior axillary line at the same horizontal level as V4.
V6\: left mid-axillary line at the same horizontal level as V4 and V5.
Once all electrodes have been applied, attach the associated chest leads, with the cable for each lead lying inferior to the
electrode (to reduce tension on the wire).
Position the patient at 45°

Limb electrode and lead placement

Apply the four limb electrodes in the following locations\:
Red (RA)\: right forearm, proximal to the wrist
Yellow (LA)\: left forearm, proximal to the wrist
Green (LL)\: left lower leg, proximal to the ankle
Black (RL)\: right lower leg, proximal to the ankle
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Avoid areas with a large amount of adipose tissue, major muscle groups or bony prominences.
Once all electrodes have been applied, attach the associated limb leads, with the cable for each lead lying inferior to the
electrode (to reduce tension on the wire).
Some people
clockwise from the right wrist.
useful for remembering the placement of the limb leads, starting
Improving skin contact with the electrodes
Hair can sometimes make it di
the hair at the electrode site.
If the skin is particularly oily you can clean the site with an alcohol wipe and allow to dry prior to electrode application.
If the skin is visibly soiled it should be cleaned, ideally with soap and water, then dried prior to electrode application.
Avoid pressing hard on the centre of the electrodes as this can cause the gel to spill outwards reducing the ability of the
electrode to stick to the skin.
Improving skin contact with the electrodes
Hair can sometimes make it di
the hair at the electrode site.
If the skin is particularly oily you can clean the site with an alcohol wipe and allow to dry prior to electrode application.
If the skin is visibly soiled it should be cleaned, ideally with soap and water, then dried prior to electrode application.
Avoid pressing hard on the centre of the electrodes as this can cause the gel to spill outwards reducing the ability of the
electrode to stick to the skin.

Recording the ECG trace

1. Turn the ECG machine on and ensure ECG paper has been loaded into the machine.
2. Double-check all the electrodes are attached in the appropriate locations.
3. Politely ask the patient to remain still and not talk during the recording as muscle activity can interfere with the ECG trace.
4. Press the appropriate button on the ECG machine to record the ECG trace. If the ECG trace is poor, double-check the
connections to ensure there is good skin contact.
https\://app.geekymedics.com/osce-guides/clinical-procedures/recording-an-ecg/ 3/411/13/24, 7\:26 PM Guide | Recording an ECG
Politely ask the patient to remain still

To complete the procedure...

Once an ECG trace has been obtained, switch o
Detach the ECG leads from the electrodes and then remove the electrodes carefully, warning the patient this may feel
uncomfortable.
Explain to the patient that the procedure is now complete.
Thank the patient for their time.
Label the ECG with the patient's details\:
Name
Date of birth
Hospital number
Indication for the ECG
Dispose of PPE appropriately and wash your hands.
Source\: geekymedics.com
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