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