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. ECTROPHY
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 hearts
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.
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

Electrocardiogram
(ECG, EKG, Resting ECG, Resting EKG)
Procedure overview
What is an electrocardiogram?
An electrocardiogram (ECG or EKG) is one of the simplest and fastest procedures
used to evaluate the heart. Electrodes (small, plastic patches) are placed at certain
locations on the chest, arms, and legs. When the electrodes are connected to an ECG
machine by lead wires, the electrical activity of the heart is measured, interpreted, and
printed out for the doctor's information and further interpretation.
Other related procedures that may be used to assess the heart include exercise
electrocardiogram (ECG), Holter monitor, signal-averaged ECG, cardiac catheterization,
chest X-ray, computed tomography (CT scan) of the chest, echocardiography,
electrophysiological studies, magnetic resonance imaging (MRI) of the heart, myocardial
perfusion scans, radionuclide angiography, and cardiac CT scan. Please see these
procedures for additional information.
The heart's electrical conduction system
The heart is, in the simplest terms, a pump made up of muscle tissue. The heart's
pumping action is regulated by an electrical conduction system that coordinates the
contraction of the various chambers of the heart.
An electrical stimulus is generated by the sinus node (also called the sinoatrial node, or
SA node), which is a small mass of specialized tissue located in the right atrium (right
upper chamber) of the heart.
The sinus node generates an electrical stimulus regularly at 60 to 100 times per
minute under normal conditions. This electrical stimulus travels down through the
conduction pathways (similar to the way electricity flows through power lines from the
power plant to your house) and causes the heart's lower chambers to contract and pump
out blood. The right and left atria (the two upper chambers of the heart) are stimulated
first and contract a short period of time before the right and left ventricles (the two lower
chambers of the heart).

Click image to enlarge

The electrical impulse travels from the sinus node to the atrioventricular node (also called
AV node), where impulses are slowed down for a very short period, then continue down
the conduction pathway via the bundle of His into the ventricles. The bundle of His
divides into right and left pathways to provide electrical stimulation to the right and left
ventricles.
This electrical activity of the heart is measured by an electrocardiogram. By
placing electrodes at specific locations on the body (chest, arms, and legs), a graphic
representation, or tracing, of the electrical activity can be obtained. Changes in an ECG
from the normal tracing may indicate one or more of several heart-related conditions.
Understanding ECG tracings
Almost everyone knows what a basic ECG tracing looks like. But what does it mean?
The first short upward notch of the ECG tracing is called the "P wave." The P wave
indicates that the atria (the two upper chambers of the heart) are contracting to pump out
blood.
The next part of the tracing is a short downward section connected to a tall upward
section. This next part is called the "QRS complex." This part indicates that the ventricles
(the two lower chambers of the heart) are contracting to pump out blood.

The PR interval corresponds to the time measured from the beginning of the P wave to
the beginning of the R (or Q) wave. The PR interval indicates the amount of time the
electrical impulses take to reach the ventricles from the sinus node.
The next short upward segment is called the "ST segment." The ST segment indicates the
amount of time from the end of the contraction of the ventricles to the beginning of the
rest period before the ventricles begin to contract for the next beat.
The next upward curve is called the "T wave." The T wave indicates the resting period of
the ventricles.
When the doctor views an ECG, he or she studies the size and length of each part of the
ECG. Variations in size and length of the different parts of the tracing may be significant.
The tracing for each lead of a 12-lead ECG will look different, but will have the same
basic components as described above. Each lead of the 12-lead ECG is "looking" at a
specific part of the heart, so variations in a lead may indicate a problem with the part of
the heart associated with a particular lead.
Reasons for the procedure
Some reasons for your doctor to request an ECG include, but are not limited to, the
following:

To determine the cause of chest pain

To evaluate other signs and symptoms which may be heart-related, such as

fatigue, shortness of breath, dizziness, or fainting

To identify irregular heartbeats

To determine the status of the heart prior to procedures such as surgery and/or
after treatment for conditions such as a heart attack (myocardial infarction, or
MI), endocarditis (inflammation or infection of one or more of the heart valves),
or after procedures such as heart surgery or cardiac catheterization

To assess the function of an implanted pacemaker

To determine the effectiveness of certain heart medications

To obtain a baseline tracing of the heart's function during a physical examination

that may be used as a comparison with future ECGs, to determine if any changes
have occurred

There may be other reasons for your doctor to recommend an ECG.

Risks of the procedure
An ECG is a quick, noninvasive method of assessing the hearts function. Risks
associated with ECG are minimal and rare.
Prolonged application of the adhesive electrode patches may cause tissue breakdown or
skin irritation at the application site.
There may be other risks depending on your specific medical condition. Be sure to
discuss any concerns with your doctor prior to the procedure.
Certain factors or conditions may interfere with or affect the results of the test. These
include, but are not limited to, the following:

Obesity, pregnancy, or ascites (accumulation of fluid in the abdomen)

Anatomical considerations, such as the size of the chest and the location of the heart
within the chestMovement during the procedure

Exercise or smoking prior to the procedure

Certain medications

Electrolyte abnormalities, such as too much or too little potassium, magnesium, and/or
calcium in the blood

Before the procedure:

Your doctor or the technician will explain the procedure to you and offer you the
opportunity to ask any questions that you might have about the procedure.

Generally, fasting is not required before the test.

Notify your doctor of all medications (prescribed and over-the-counter) and herbal
supplements that you are taking.

Notify your doctor if you have a pacemaker.

Based on your medical condition, your doctor may request other specific preparation.

During the procedure

An ECG may be performed on an outpatient basis or as part of your stay in a hospital.
Procedures may vary depending on your condition and your doctors practices.
Generally, an ECG follows this process:

You will be asked to remove any jewelry or other objects that may interfere with the
procedure.

You will be asked to remove clothing from the waist up. The technician will ensure
your privacy by covering you with a sheet or gown and exposing only the necessary
skin.

You will lie flat on a table or bed for the procedure. It will be important for you to lie
still and not talk during the procedure, so as not to interfere with the tracing.

If your chest, arms, or legs are very hairy, the technician may shave or clip small
patches of hair, as needed, so that the electrodes will stick closely to the skin.

Electrodes will be attached to your chest, arms, and legs.

The lead wires will be attached to the skin electrodes.

Once the leads are attached, the technician may key in identifying information about
you into the machine's computer.

The ECG will be started. It will take only a short time for the tracing to be completed.

Once the tracing is completed, the technician will disconnect the leads and remove the
skin electrodes.

After the procedure

You should be able to resume your normal diet and activities, unless your doctor instructs
you differently.
Generally, there is no special care following an ECG.
Notify your doctor if you develop any signs or symptoms you had prior to the test (for
example, chest pain, shortness of breath, dizziness, or fainting).

Your doctor may give you additional or alternate instructions after the procedure,
depending on your particular situation.
Online resources
The content provided here is for informational purposes only, and was not designed to
diagnose or treat a health problem or disease, or replace the professional medical advice
you receive from your doctor. Please consult your health care provider with any questions
or concerns you may have regarding your condition.
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