Performing An Ecg

Front 1

Information on Requisition From

Back 1

Patients name, identification number or medical records number, and birth date

Front 2

Computerized Requisition System

Back 2

ECG frequently entered through the computerized system. Entering patient identification through the computer will generate patient cahrges. Without a compute system, information should be handwritten on the order form, consult, or requisition, whichever your facility uses.

Front 3

The Joint Commission (TJC) formerly known as The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) identification requirements

Back 3

This agency states that every patient should be identified by his or her name, a medical record number, and or verification of the patient's birth date with the patient's statement. If the patients information is incorrect verify with your immediate supervisor for the next steps

Front 4

Legal records

Back 4

the ECG is part of the medical records. Enter the patient information thoroughly and accurately. Remember, the patient's medical record can be used as part as a medical professional liability case

Front 5

Appropriate actions when a patient refuses an ECG

Back 5

determine the cause of the refusal. Some people may have fear or concern about the procedure. Provide any information or reassurance the patient may need. if the patient still refuses notify your supervisor and/or the ordering physician; the patients reason for refusal must be documented

Front 6

Patient privacy during the ECG

Back 6

provide privacy by pulling the curtain around the bed or closing the examination room door.

provide patient with a drape, such as a sheet or blanket

Front 7

Items that should be removed from patients body during the ECG

Back 7

the patient should remove any jewelry or items that would interfere with the electrode placement or touch electrodes. This may include watches, necklaces, bracelets, belt buckles, or ankle bracelets.

Front 8

Items that should be turned off and removed from the patient

Back 8

cellphones, PDA, MP3 players, and beepers

Front 9

Proper patient identification

Back 9

check the patients name and medical record or patient identification number and verify it with the patient's birth date prior to performing any procedure on a patient

Front 10

The side of the exam table that is best to work with

Back 10

The left side of the exam table, because most of the electrodes and leads are placed on the left side of the chest

Front 11

The exam table should not touch

Back 11

the wall or any electrical equipment and that the patient is not touching any metal

Front 12

Midclavicular line

Back 12

An imaginary line on the chest that runs vertically through the center of the clavicle

Front 13

Anterior axillary line

Back 13

An imaginary vertical line starting at the from axilla (armpit) that extends down the left side of the chest

Front 14

Midaxillary line

Back 14

An imaginary vertical line that starts at the middle of the axilla (armpit) and extends down the side of the chest

Front 15

How to feel the intercostal space (space between two ribs)

Back 15

Locate the sternum. Press your fingers tot eh edge of the sternum on the left or right side. The outer edge of the sternum is known as the sternal border. Between each connect rib you should feel a dip or dent.

Front 16

Suprasternal Notch

Back 16

The dip you fell at the anterior base of the neck just above the manubrium where the clavicle attaches to the sternum

Front 17

Angles of Louis

Back 17

A ridge about an inch or so below the suprasternal notch where the main part of the sternum and the top of the sternum, known as the manubrum, are attached

Front 18

Lead placement

Back 18

The leads should be placed on the same site on each arm so that the placements are mirror images of each other.

The leads should be placed on the same site on each leg as well

Front 19

Before applying electrodes

Back 19

make sure the skin at the site is clean and dry. Remove any lotion or oil from the skin with alcohol wipes or soap and water

Front 20

Shaving electrode site

Back 20

small areas of the chest may be shaved, but it is preferred to clip the hair instead of shaving. This prevents the patient from scratching the electrode site as the hair grows in

Front 21

How do you start applying electroces

Back 21

Start by applying V1 electrode. First locate the Angle of Louis; then locate the second rib, which is adjacent to this landmark. Each intercostal space is felt between the ribs with the corresponding intercostal space below the rib location

Front 22

Where is V1 chest lead placed

Back 22

the fourth ICS at the right sternal border at this location

Front 23

Where is V2 chest lead placed

Back 23

the fourth ICS at the left sternal border at this location

Front 24

Where is V3 chest lead placed

Back 24

This chest lead is placed after you place V4. This chest lead is placed midway between V2 and V4

Front 25

Where is V4 chest lead placed

Back 25

Chest lead placed before V3. Placed at the fifth intercostal space on the left midcavicular line. Locate the intersection between the fifth intercostal space and the midcavicular line. In young people its usually directly below the nipple

Front 26

Where is V5 chest lead placed

Back 26

Chest lead placed at the same horizontal level as V4, this lead is placed at the anterior axillary line

Front 27

Where is V6 chest lead placed

Back 27

placed at the midaxillary line on the same horizontal line as V4.

Front 28

Another method of placement for V5 and V6

Back 28

place V6 first then place V5 midway between V4 and V6

Front 29

Anatomical landmarks when placing electrodes

Back 29

should always be located and you should never place them visually

Front 30

Proper placing of ECG wire cables

Back 30

Cables should follow the contours of the body when attached to the ECG electrodes. Avoid crossing or looping the wires outside the body, and check wire once it is connected to ensure that there is no tension on the electrodes or leads. Individual loop may be used to take up slack and prevent looping outside the body, thus reducing tension on the electrode

Front 31

What does the acronym "snow above grass, smoke above fire, ground" mean

Back 31

white and green, black and red, brown

Front 32

Checking prongs before ECG

Back 32

Prior to performing the ECG, check to be sure that the grounding prong is securely attached tot eh plug. Plug the machine in securely. ensure that the bed or exam table is not touching the wall or any electrical equipment

Front 33

Proper assistance with patient and machine

Back 33

Assist the patient to dress and undress as needed to provide for comfort and safety. Once the procedure is complete, you should clean the lead wires, leads, and machine

Front 34

Before operating the ECG machine you have to make sure you do this

Back 34

1. Identified and communicated with the patient

2. Prepared the patient and the room

3. Provided for patient privacy

4. Provided for safety and infection control

5. Located and checked the equipment for functioning

6.Loaded the ECG graph paper, if neccesary

7. Attached the electrodes and leads

Front 35

ECG machines and what to do

Back 35

Most ECG machines are automatic and mark the lead codes. If the equipment you are using does not, mark each code manually during the tracing. while the ECG is running, change the lead code dial, then mark each lead

Front 36

How many inches of complex should you run for leades I, II, III?

Back 36

8-10 inches

Front 37

Artifacts

Back 37

unwanted marks on the ECG

Front 38

Somatic tremor

Back 38

Voluntary or involuntary muscle movement; also known as body tremors

Front 39

Causes of voluntary muscle movement

Back 39

tension, fear, gum chewing, talking, uncomfortable position, or pain. They may also be due to shivering or tense muscle

Front 40

Causes of involuntary muscle movement

Back 40

Parkinson's disease or other nueromuscular disease. Patients with this disorder need can put their hands under their buttocks to reduce movement

Front 41

Wandering baseline

Back 41

also known as the base line shift. Occurs when the tracing drifts away from the center of the graph paper

Front 42

Causes of WANDERING BASELINE (or baseline shift)

Back 42

1. To loose or incorrect electrode application

2. tension or pulling on the electrode lead wires

3. Too little electode gel or solution

3. Old or dried out electrode gel or solution

4. Corroded or dirty electrodes

5. Oil, lotion, dirtor hair under the electrodes

6. Poor or no skin preperation

Front 43

AC (alternating current) interference

Back 43

Unwanted markings on the ECG casued by other electrical current sources

Front 44

Two copies of the ECG tracing are necessary for this

Back 44

one to be placed on the patients chart and theother to be read by the consulting physician

Front 45

Billing for ECG

Back 45

billing is another issue to consider when reporting completion of an ECG. When you enter the data into the machine or on the designated form, it must be completed and accurate. If the patient is not charged for the procedure, this can have an adverse effect on the hospital's finances and subsequently your job. Check the facility policy to be certain you have completed the necessary steps to nsure that the patient will be charged

Front 46

General day-to-day care of the ECG machine

Back 46

cleaning the ECG machine and stocking the supplies, such as electrodes, skin preparation, paper, and cleaning supplies

Front 47

How to take care of disposable electrodes

Back 47

Carefully maintain the alligator tips used for attachment. Check them to ensure that the pins fit snugly on the electrode. Check for small amounts of electrolyte paste or gel that may cling to clips. There bits of paste may prevent good contact with the electrodes

Front 48

How to speak to a child during an ECG

Back 48

Avoid technical words like electrodes adn electrocardigram. Use the words "stickers" to describe electrodes

Front 49

Chest lead placement for children

Back 49

Because of crowding on the chest, it may be necessary to move the V3 lead to the right side of the chest. It should be placed on the right side in the same location as it normally would be on the left. this is known as V3 right (V3R)

Front 50

Considerations when placing leads and recording tracings in a patients chart

Back 50

-if a women has had a mastectomy, be careful placing the electrodes, the skin may be fragile. Note that the patient had a mastectomy and which breast is affected of the ECG tracing

-a pregnant women should have the lower limb leads placed on the thighs, not the abdomen. Place the patient on her left side slightly, by using a small rolled towel under the right hip to reduce pressure on the inferior vena cava. Document on the ECG that the patient is pregnant

-a condition known as DEXTROCARDIA, is when the heart is on the right side of the chest rather than on the left. In this case the physician would order a right-side 12-lead ECG. The leads are reversed (mirror image) from the usual lead placement. This is the only case where the aVR tracing will produce a positive deflection. On the ECG tracing report, you should indicate that you did a right-side ECG

Front 51

Dextrocardia

Back 51

When the heart is on the opposite or right side of the chest

Front 52

ECG during a cardiac or respiratory arrest

Back 52

Perform two ECGs in a row. Perform the first ECG and leave the electrodes in place in order to perform the second ECG quickly. Indicate on the tracing "repeat ECG--same lead placement", this will make the physician aware that the electrodes were not removed in between tracings

Front 53

Procedure for seizure during an ECG

Back 53

Stay with him or her. Protect the patient from injury. Do no try to restrain the patient. Call for help, and report the seizure. Once the seizure is over, perform the ECG again and write on the ECG strip "postseizure"