Lesson 1: Types of ECG s

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1 Electrocardiography Lesson 1: Types of ECG s Objectives: Distinguish between a single-channel ECG machine and a multi-channel machine. Distinguish between a manual ECG machine and an automatic ECG machine. State that the ECG mount forms a permanent record of the ECG for the patient s file. Match characteristics to the correct type of machine. Student Tasks 1. Compare single-channel and multi-channel ECG s. 2. Compare manual and automatic ECG s. 3. Describe how the line is created on tracing paper. 4. Explain the purpose of an ECG mount. 5. Complete all Lesson 1 questions. Copyright 2012 Applied Educational Systems Page 1 of 1

2 Electrocardiography Lesson 2: Standardization Objectives: Explain that the horizontal lines on the graph measure time and the vertical lines measure voltage. Recognize that one-half standardization records ECG cycles at half of their normal height while double standardization records ECG cycles at twice their normal height. State that normal paper speed is 25 mm per second. Prerequisites Students must have completed the following lessons prior to beginning this lesson: Performing a Standard Resting ECG, Lesson 1 Types of ECG s Student Tasks 1. Describe the graph lines on ECG tracing paper. 2. Compare normal standardization to one-half and double standardization. 3. Properly adjust the position and heat of the stylus. 4. Explain when to use different paper speeds. 5. Complete all Lesson 2 questions. Copyright 2012 Applied Educational Systems Page 1 of 1

3 Electrocardiography Lesson 3: Artifacts Objectives: Describe an artifact as something that creates interference on an ECG. Name somatic tremor, AC interference, wandering baseline, and interrupted baseline as four common types of artifacts. Describe how to make adjustments to perform ECG s on patients with special issues. Prerequisites Students must have completed the following lessons prior to beginning this lesson: Performing a Standard Resting ECG, Lesson 1 Types of ECG s Performing a Standard Resting ECG, Lesson 2 Standardization Student Tasks 1. Define artifact. 2. List different types of artifacts. 3. Identify the source of artifacts. 4. Explain ways to avoid artifacts in an ECG. 5. Complete all Lesson 3 questions. Copyright 2012 Applied Educational Systems Page 1 of 1

4 Electrocardiography Lesson 4: Automatic 12 Lead ECG Objectives: Explain that the assistant is responsible to record the ECG and make sure it can be easily read and understood by the physician. Practice the procedure for an automatic 12-lead ECG. Prerequisites Students must have completed the following lessons prior to beginning this lesson: Performing a Standard Resting ECG, Lesson 1 Types of ECG s Performing a Standard Resting ECG, Lesson 2 Standardization Performing a Standard Resting ECG, Lesson 3 Artifacts Student Tasks 1. Describe the role of the assistant in an ECG. 2. Prepare the room and equipment for a standard ECG. 3. Prepare a patient for a standard ECG. 4. Operate the ECG machine. 5. Mount the tracing. 6. Complete all Lesson 4 questions. Materials The items below are needed for this lesson: Automatic ECG machine (multi-channel or single-channel), with tracing paper and lead wires 10 disposable electrodes Patient gown Drape Blanket Pillows Gauze Pads Alcohol Moist paper towel Disposable shaving supplies ECG Mount Exam table Procedure Checklist: 12-Lead ECG Copyright 2012 Applied Educational Systems Page 1 of 1

5 12 LEAD ECG Gather Materials PASS REPEAT 1. Gather the supplies for the procedure. You will need: Automatic ECG machine (multi-channel or single-channel), with tracing paper and lead wires 10 disposable electrodes Patient gown Drape Blanket Pillows Gauze pads Alcohol Moist paper towel Disposable shaving supplies (if needed) ECG Mount Prepare the Room and Equipment PASS REPEAT 2. Cleanse your hands. 3. Turn off all electrical equipment in the room that may cause interference. 4. Make sure the room is quiet and at a comfortable temperature. 5. Cover the exam table with a sheet or paper covering. 6. Check that the date of inspection on the ECG machine is current. 7. Plug in the machine. The outlet should be away from known electrical interference. 8. Plug the patient cable with the lead wires into the machine. 9. Turn on the machine and allow the stylus to warm up as needed. 10. Cleanse your hands. Copyright 2007 Applied Educational Systems Page 1

6 12 LEAD ECG (CONTINUED) Orient the Patient and Check Vital Signs PASS REPEAT 11. If entering a patient s room, first knock on the door. 12. Address the patient by name and introduce yourself. 13. Identify the patient by checking the patient chart. 14. Explain the procedure and answer any questions. Try to relieve any anxiety the patient may have. 15. Check these vital signs for the patient: Pulse Respirations Blood Pressure Position the Patient PASS REPEAT 16. Ask the patient to disrobe from waist up, remove jewelry, and uncover the lower legs. Socks can be worn, but full-length nylon stockings must be removed. For a female patient, provide a gown and instruct her to wear it with the opening in the front. 17. Provide the patient with privacy. Record the vital signs on the patient s chart at this time. 18. When ready, assist the patient onto the table in a supine position. Then pull out the leg rest. If the room is cool, cover the patient with a drape or blanket from just above the waist to just below the knees. If the patient has difficulty breathing or cannot lie flat, use a Fowler s or a semi-fowler s position. Adjust pillows under the head and/or knees for comfort as needed. 19. Tell the patient to rest quietly and breathe normally. Prepare the Patient s Skin PASS REPEAT 20. Prepare the patient s skin at each site where an electrode will be attached. Moisten a gauze pad with alcohol and wash the area to remove skin oil. Rub the skin vigorously with a dry gauze pad to increase circulation. If the patient s leg or chest hair is dense, put on gloves and shave an area just large enough for the electrode. Properly dispose of the razor and gloves when you are finished, and observe Standard Precautions. Copyright 2007 Applied Educational Systems Page 2

7 12 LEAD ECG (CONTINUED) Apply the Limb Electrodes PASS REPEAT 21. Apply the electrodes to the fleshy outer area of the upper arms, with the tabs pointing down. Peel off the backing off each electrode. Press the electrode into place using a smooth, even motion. Make sure that the electrodes on both arms are placed at the same level. 22. Apply the electrodes to the fleshy inner area of the lower leg near the calf, with the tabs pointing up. Peel off the backing off each electrode. Press the electrode into place using a smooth, even motion. Make sure that the electrodes on both legs are placed at the same level. Apply the Precordial Electrodes PASS REPEAT 23. Count the intercostal spaces for the first precordial lead. 24. Apply the precordial electrodes at specified sites on the chest, with the tabs pointing down. Be sure to place the electrodes for V2 and V4 before the one for V3. Peel off the backing off each electrode. Press the electrode into place using a smooth, even motion. Attach the Lead Wires PASS REPEAT 25. Place the machine with the power cord pointing away from the patient. 26. Attach the lead wires. The wires are labeled and color-coded. They may clip, snap, or screw into place. Make sure all wire tips follow the patient s body contours. Do not allow any wires to touch the power cord for the ECG machine or to go underneath the table. 27. Check all the electrodes and wires for proper placement and connection. 28. Drape the wires over the patient to avoid tension on the electrodes. If there is excess wire, coil it and fasten the loop. Make sure the patient cable is supported, either on the table or the patient s abdomen. Copyright 2007 Applied Educational Systems Page 3

8 12 LEAD ECG (CONTINUED) Operate the ECG Machine PASS REPEAT 29. Enter the patient data into the ECG machine. 30. Remind the patient to breathe normally and lie still. Explain that it is important not to move or talk in order to prevent false readings. 31. Adjust any settings for the machine as required: Set the paper speed. The standard speed is 25 mm per second. Set the sensitivity. The standard setting is 1. Center the stylus. Press the standardization button. Check that the correct mark is produced. The standard mark is 10 small squares high and 2 small squares wide. Check the color of the line. If needed, adjust the stylus heat control. 32. Press the Auto button to record the tracings. Check the Tracings PASS REPEAT 33. Check the tracings for artifacts. 34. Correct any problems and repeat those tracings that are not clear. Check that the limb and chest leads are still attached properly. Eliminate electrical interference. Improve patient comfort, if possible. 35. Remove the tracing from the machine. 36. Make sure the tracing is labeled with the proper patient information. Dismiss the Patient PASS REPEAT 37. Turn off the machine. 38. Disconnect the lead wires from the electrodes. 39. Remove the electrodes from the patient. Clean the patient s skin as needed with a moist paper towel and then dry the skin. 40. Properly discard the electrodes and paper towels. 41. Assist the patient to a sitting position. Allow a moment for rest, and then assist the patient from the table. 42. Provide the patient privacy to dress, or if needed, help the patient dress. Copyright 2007 Applied Educational Systems Page 4

9 12 LEAD ECG (CONTINUED) Post Procedure Actions PASS REPEAT 43. Cleanse your hands. 44. Mount the tracing. For a multi-channel machine, the single sheet of paper may be attached to a self-stick mount. For a single-channel machine, cut the strip into leads and attach each one to the correct area of the mount. 45. Update the patient s record. Place the tracing in the patient s chart. Document the procedure in the chart. 46. Give the record to the physician for review. If the patient had complaints or if there were unusual findings, notify the physician at once. 47. Clean and disinfect the equipment and the room according to OSHA guidelines. Properly discard used materials. Change the table paper and pillow cover. Copyright 2007 Applied Educational Systems Page 5

Electrocardiography for Healthcare Professionals

Electrocardiography for Healthcare Professionals Kathryn A. Booth Thomas O Brien Chapter 4: Performing an ECG Learning Outcomes 4.1 Carry out preparation of the patient, room, and equipment for an ECG.