ELECTROCARDIOGRAM (ECG)

DEFINITION THE HISTORY OF ECG MACHINE

• An - electrocardiogram (ECG) is a non-invasive

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1903 - Willem Einthoven
medical test that detects cardiac (heart)
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abnormali=es by measuring the electrical ac=vity A Dutch doctor and physiologist. He invented the first
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prac=cal electrocardiogram and received the Nobel Prize

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generated by the heart as it contracts.

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• The machine that records the pa=ent’s ECG is in Medicine inD1924 for it.
called an electrocardiograph.
• There is no difference between an ECG and EKG. NOW - Modern ECG machine
• Both refer to the same procedure.
Has evolved into compact electronic systems that oNen
• One is in English (electrocardiogram – ECG) -

include computerized interpreta=on of the

• The other is based on the German spelling -

electrocardiogram.
(elektrokardiogramm – EKG)
• The most common ECG is called the ↳ 12-lead ECG. PURPOSE OF ECG

• To help iden=fy primary conduc=on

abnormali=es, cardiac arrhythmias, cardiac
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hypertrophy, pericardi=s, electrolyte imbalances,

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myocardial ischemia and the site and extent of

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myocardial infarc=on.
• To monitor recovery from an MI.
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• To evaluate the effec=veness of cardiac

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medica=on.
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• To assess pacemaker performance.

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• To determine effec=veness of thromboly=c

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therapy and the resolu=on of ST-segment

e

depression or eleva=on and T-wave changes.

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An -
early ECG machines. The pa=ent’s hands and leN foot
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are immersed in saltwater tubs to conduct electrical

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signals from his skin to the machine. Na=onal Heart

Hospital, London,-
1916.

A-12 lead ECG, there are 10 wires on an ECG machine that

e n

are connected to specific parts of the body, specifically, 6

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chest leads and 4 limb or peripheral leads.

 ELECTROCARDIOGRAM (ECG)

What is ar=fact? Broken recording – can caused by a fractured wire or

electrode cable.
--
Ar<fact – is unwanted interference or jiber on the ECG
tracing. This makes ECG reading difficult. Nursing Ac=ons:

4 kinds of ar=fact: • Check for loose electrodes or cables

• Never do an ECG with a faulty machine
Soma<c tremors – a jibery pabern caused by the
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pa=ent’s tremors or by shaking wires.

-long/short lines

Nursing Ac=ons:

• Try to help the pa=ent relax

• Cover him if he’s cold
• Make sure the wires are not tangled or loose

guri-guri

Baseline sway – this is where the baseline moves up and

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down on the ECG paper

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- it’s oNen caused by lo=on or sweat on

the skin
- some=mes its associated with the
breathing pabern
V1 should be posi=oned at the 4th Intercostal space to the
Nursing Ac=ons: right of the sternum.
• Wipe off any lo=on or sweat on the skin V2 is to be placed at the 4th intercostal space to the leN of
• Apply alcohol the sternum.
• Advise pa=ent to relax
wire
V3 midway between V2 and V4.
parang
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V4 must be then posi=oned at the 5th Intercostal space at

the midclavicular line.
60-cycle interference- results in a thick-looking pabern
on the paper.
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V5 at the anterior axillary line at the same level as V4.

- it caused by too many electrical things V6 is to be placed at the midaxillary line at the same level
plugged in close by. as V4 and V5.

Nursing Ac=ons:

• Unplug as many machines as you perform ecg

• Cellphones can also cause interference.

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makapal
 ELECTROCARDIOGRAM (ECG)

Another way to posi=on accurately the leads is to first PREPARATION

iden=fy the “angle of Louis”, or sternal angle”, which can
be found when you place your fingers gently at the base • Gather equipment.
of your throat in a central posi=on and move your fingers • Wash hands
gently at the base of your fingers downward un=l you can • Check the pa=ent’s iden=fica=on.
feel the top of the sternum or rib cage. • Explain to the pa=ent the need to lie s=ll, relax,
and breathe normally during the procedure.
Then, con=nue to move your fingers downward un=l you • Explain that the test is painless and takes 5 to 10
feel a boney lump, which is the “angle of Louis”. minutes and no electrical current will enter the
body of the pa=ent.
From then on move your fingers o the right and you will • Remove all jewelry and metal abach to the body.
feel a gap between the ribs. This gap is the 2nd Intercostal • Check the ECG machine is plugged in and turned
space. From this posi=on, run your fingers downward it on.
across the next rib, and the next one. The space you are
in is the 4th intercostal space. Where this space meets the PROCEDURE
sternum is the posi=on for V1.
• Place the pa=ent in a supine or semi-fowler’s
Do this again, but this =me to the leN. Where this space posi=on
meets the sternum (at the 4th intercostal space) is the • Expose the chest, ankles, and wrists.
posi=on for V2. From this posi=on, slide your fingers
• Place electrodes on the pa=ent
downward over the next rib and you are in the 5th
• ANer all electrodes are in place, press the START
intercostal space, look at the chest and iden=fy the leN
bubon and input any required informa=on.
clavicle. The posi=on for V4 is the 5th intercostal space, in
• Make sure that all leads are represented in the
line with the middle of the clavicle (mid-clavicular line).
tracing. If not, determine which electrode has
V3 sists midway between V2 and V4. Follow the 5th come loose, reabach it and restart the tracing.
intercostal space to the leN un=l your fingers are • All recording and other nearby electrical
immediately below the beginning of the axilla, where you equipment should be properly grounded.
will posi=on V5. • Make sure that the electrodes are firmly
abached.
Follow this line of the 5th intercostal space a lible further • ANer the procedure, disconnect the equipment,
un=l you are immediately below the center point of the remove the electrodes and remove the gel with
axilla (mid-axillary line). This is the posi=on for V6. a moist cloth towel.
• If the pa=ent is having recurrent chest pain or if
MONITORING THE ECG serial ECG’s are ordered, leave the electrode in
place.
Equipment Needed
Precau<ons
• Twelve-lead ECG machine with charged babery,
cables and leads, graph paper • The recording equipment and other nearby
• Disposable electrodes (12) electrical equipment should be properly
• Electrode paste or gel grounded to prevent electrical interference.
• Alcohol wipes • Double-check color codes and lead markings to
• Pillows be sure connectors match.
• Sheet or drape • Make sure that the electrodes are firmly
• Towel and washcloth abached and reabached them if loose. Don’t use
• Disposable razor cables that are broken or bare.

Complica<ons

• Skin sensi=vity to the electrodes.

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V1
V2

Y
v5
VP
,A
RAIL
RL