PROTOCOL FOR ECG RECORDING –
ECG recording is an essential diagnostic tool for the immediate assessment of patients
suffering from chest pain and for the routine screening of cardiac pathologies. In the
same way, general nurses should perceive the ECG as another means of expanding their
scope of professional practice which benefits the patients in their care. NORMAL
ELECTROPHYSIOLOGY THE HEART
A specialised electrical conducting system in the heart ensures an orderly contraction so
that the heart can act as an efficient pump. Below the right atrium is the sinoatrial (SA)
node, an area of specialised muscle fibres that propagates the heart’s contraction
stimulus. It has the ability, in the absence of external stimuli, to initiate electrical
impulses at a rate of approximately 100 per minute. Other areas of the heart also possess
this ability, called automacity (Nash and Nahas 1996), but because the SA node produces
the fastest rate, it assumes the role of pacemaker. CORDING THE ECG
When taking an ECG recording, either via a monitor or ECG machine, electrodes are
applied to the patient at strategic points.
POSITIONING OF LEADS stem of the
V1 4th intercostals space on the right sternal border Clavicle
V2 4th intercostals space on the left sternal border
V3 between V2 and V4
V4 5th intercostal space on the mid clavicular line
V5 between V4 and V6 on the same horizontal plane
V6 Mid axilliary on the same horizontal plane as V4 and V5
Right arm lead (RA)
Left arm lead (LA)
Right leg lead (RL)
Left leg lead (LL)
PROCEDURE
Explain to the patient what you are going to do and in simple terms what an ECG looks
for and why they are having one done.
Sit the patient in semi-prone position comfortably with shirts, blouses, bras and socks
removed.
If the patient is male and the chest is particularly hairy, it will need to be shaved.
Connect the leads as above.
If the lines of the tracing appear slightly blurred, the filter should be applied.
Press the button according to the make of the ECG machine to run off a hard copy of the
tracing.
The person taking the ECG should sign the ECG and date it. If the ECG was done as an
emergency measure the GP should be shown the reading immediately, if it is a routine
measure, it should be put in their tray. If no GP available it can be faxed to the on-call
Registrar in CCU at the Victoria Hospital, Kirkcaldy
Document in the patients notes and on the computer that the ECG has been done.
The Seca ECG machine should be left on charge and disconnected from the mains prior
to use as per manufacturers guidelines. There is no risk of electrocution it reduces the
electrical interference.
The ECG machine should be serviced yearly
REFERENCES
http://www.nursing-standard.co.uk/archives/residentpdfs/quickrefPDFfiles/Quickref4.pdf