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Proper ECG Acquisition Techniques and Guidelines for Patient Safety

This guide outlines the essential steps for acquiring an ECG on a simulated patient in various conditions. It details indications for ECG monitoring, including patients with chest pain or other cardiac symptoms, while emphasizing the importance of avoiding electrode placement on damaged skin. Key steps include correctly attaching limb leads, managing life-threatening rhythms promptly, ensuring proper skin preparation, and maintaining patient comfort. Health professionals must utilize PPE throughout the procedure, ensure leads are accurately placed, and obtain a clear 12-lead ECG reading to facilitate accurate cardiac assessment.

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Proper ECG Acquisition Techniques and Guidelines for Patient Safety

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  1. ECG Acquisition

  2. Conditions • The candidate should perform this skill on a simulated patient under existing indoor, ambulance, or outdoor lighting, temperature, and weather conditions.

  3. Indications • Any patient exhibiting chest pain of probable cardiac origin • Any patient exhibiting other symptoms of a possible myocardial infarction

  4. Red Flags • Avoid attaching electrodes to skin that is burned, injured, or otherwise not intact. • Do not delay the management of life-threats for acquisition of an ECG.

  5. PPE!

  6. Explain procedure to patient

  7. Place limb leads

  8. “White on right” arm

  9. Black on left arm

  10. Red on left leg

  11. Green on right leg

  12. Avoid placing leads on the torso

  13. MCL1 (V1) should be placed in 4th intercostal space, right of sternum (if desired)

  14. Secret: Place leads on shoulders and lower abdomen if too much artifact

  15. Turn monitor on

  16. Assess baseline rhythm

  17. Print tape as necessary

  18. 12-lead ECG

  19. Treat life-threatening rhythms prior to 12-lead

  20. Expose the chest

  21. Ensure skin is intact

  22. Shave hair as necessary

  23. Clean with alcohol pad if soiled

  24. Alcohol must dry before placing electrodes

  25. Attach cables to self-adhesive leads

  26. Attach precordial leads

  27. Secret: Left and right are always from the perspective of the patient R L

  28. V1 – 4th intercostal space, right of the sternum

  29. V2 – 4th intercostal space, left of the sternum

  30. V4 – 5th intercostal space, midclavicular line

  31. V3 – on a line midway between V2 and V4

  32. V5 – anterior axillary line on same horizontal level as V4

  33. V6– midaxillary line at same level as V4 and V5

  34. Connect precordial leads to monitor

  35. Direct patient to remain still and breathe normally

  36. Obtain 12-lead

  37. If data is “noisy,” adjust appropriate lead and retake 12-lead

  38. Use PPE!!!

  39. Ensure skin is clean and clear prior to lead placement

  40. Accurately place leads on patient

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