How to Perform ECG?

Performing an electrocardiogram (ECG or EKG) involves a series of steps to accurately record the electrical activity of the heart. Here's a breakdown of the process:

Preparation

1. Explain the Procedure: Inform the patient about the ECG process, including the importance of remaining still and breathing normally. Address any concerns they might have.
2. Patient Positioning: Have the patient lie comfortably on their back (supine position) on an examination table or bed. Ensure they are relaxed to minimize muscle artifacts.
3. Skin Preparation: Identify the electrode placement sites (described below). Gently clean and, if necessary, shave any hair from the skin at these sites to ensure good electrode contact. Alcohol wipes can be used to cleanse the skin.
4. Equipment Check: Verify that the ECG machine is properly calibrated and functioning. Ensure you have enough electrodes and conductive gel.

Electrode Placement

This section details the standard 12-lead ECG placement.

Limb Leads

• Right Arm (RA): Below the right clavicle.
• Left Arm (LA): Below the left clavicle.
• Right Leg (RL): On the right lower abdomen or upper inner ankle. This is the ground electrode.
• Left Leg (LL): On the left lower abdomen or upper inner ankle.

Chest Leads

• V1: Fourth intercostal space, right sternal border.
• V2: Fourth intercostal space, left sternal border.
• V3: Midway between V2 and V4.
• V4: Fifth intercostal space, midclavicular line.
• V5: Fifth intercostal space, anterior axillary line.
• V6: Fifth intercostal space, midaxillary line.

Recording the ECG

1. Electrode Application: Apply a small amount of conductive gel to each electrode to enhance signal transmission. Firmly attach the electrodes to the prepared skin sites according to the locations specified above.
2. Lead Connection: Connect the leads from the ECG machine to the corresponding electrodes, ensuring they are securely attached and not tangled. Use color-coded cables if available to aid identification.
3. Data Entry: Enter the patient's information (name, age, sex, date of birth, medical record number) into the ECG machine.
4. Recording Start: Instruct the patient to remain still and breathe normally. Start the ECG recording. Monitor the tracing to ensure a clear signal.
5. Artifact Management: Observe the ECG tracing for artifacts (e.g., muscle tremor, 60-cycle interference). If present, address the cause (e.g., reassure the patient, check electrode contact, remove electronic devices).
6. Recording Duration: Record the ECG for the required duration (usually 10 seconds per lead).
7. Review and Print: After recording, review the ECG tracing to ensure it is complete and of good quality. Print the ECG.

Post-Procedure

1. Electrode Removal: Gently remove the electrodes from the patient's skin.
2. Clean Up: Clean any remaining gel from the patient's skin.
3. Data Storage: Store the ECG data electronically and physically (printed copy) according to your facility's protocols.
4. Interpretation: The ECG should be interpreted by a trained healthcare professional (e.g., physician, cardiologist, nurse practitioner).

By following these steps, healthcare providers can accurately perform an ECG and obtain valuable information about a patient's cardiac health.