1. ECG TRAINING MODULE 2 BY
BRAD CHAPMAN RCT

2. OBJECTIVES PATIENT APPROACH LEAD PLACEMENT ARTIFACT
SPECIAL NEEDS PATIENTS

3. The Approach Enter to the left hand side of the patient
Ensure them that this test doesn't hurt
Make sure curtain is pulled across for the women
Ask the Men if they want the curtain pulled – most won't but occasional one will

4. Patient Preparation
Tell patient that you are going to place stickers on them and then connect some wires
Start by placing a sticker on either the arms or legs first – this helps to show that this test is non-invasive and helps to relieve anxiety

5. Placement of Leads
Find the first intercoastal space by moving a finger down the right collar bone towards the sternum. Stop a ½ “ before the sternum
Rock fingers down chest counting the intercostal spaces
Count down to the 4th intercostal space
Place a sticker there
Repeat process on the other side of the sternum

6. Placement of leads
Draw a vertical line from mid-clavicular to under the breast and place a sticker. This will be V4.
Place sticker in between v2 and v4
This sticker would be on a diagonal plane between v2 and v4
Visual drop a horizontal line straight line down from v4 to mid-auxilla and place a sticker (v6)
Place a sticker between v4 and v6 – this will be your v5 lead

8. Chest Lead Placement All chest leads are labelled v1, v2, v3,...v6.
All leads are color coded.
Chest leads are
Red
Yellow
Green
Blue
Orange
Purple

9. Easy to remember Stop Light Red, Yellow, Green BOP
Blue, Orange, Purple

10. Artifact There are different types of artifact
Somatic tremors (muscle artifact) – most common
Wandering baseline
AC interference

11. Somatic Tremors (Muscle artifact)
CAUSE
Most common type of artifact
Caused by patient moving limbs, fingers, nervous, restless, or anxious
REMEDY
Try to have the patient relax and hold still
Try talking in a calming
voice while doing the tracing
Move limb stickers higher
up the limb

12. Wandering Baseline CAUSE
Patient is moving or stickers are not making a good contact
Cables may be dangling or swaying
REMEDY
Place a towel on chest leads
to weight them down
Apply pressure to lead
with a towel

13. AC Interference Consistent and regular saw tooth pattern REMEDY
Turn off all cell phones and other electronic devices (possibly lights)
Unplug electric bed
TENS machines must
be turned off to do ECG
Place ECG machine further
away from ventilators, IV pumps
X-Ray equipment
Radio and TV

15. Where is that Artifact coming from?
If there is artifact in Check this connection
these leads
Lead I and II RA
Lead I and III LA
Lead II and III LL OR
Tap on or shake the limb lead and see where the interference is coming from

16. Special Needs Patient Amputees Burns Tremors Paediatrics Wheelchair
Trauma
SOB
Acute MI
Psychiatric

17. AMPUTEES Place lead further up the limb or even on the hip or shoulder
You can put both leg leads on the left leg as long as the left lead is higher up the leg then the right leg lead

18. BURNS Place leads on parts of the skin that are not burnt
Do not remove any clothing that is stuck to the skin
Take alligator clip off the end of the lead, clean with alcohol and hold the tip of the lead on the skin lightly

19. TREMORS Parkinson’s disease Place hands underneath the buttocks
Place electrodes on Hips or Shoulders
Add extra pillow under knees

20. PEDIATRICS
Getting small children to hold still during an ECG may be challenging
Distraction with toys or Music
Young infants, place stickers on then wrap in a blanket

21. WHEELCHAIR Assist to transfer to bed
If they can’t move to bed – do ECG in the chair
Record on the ECG that done while sitting up. (Changes the axis of the heart)

22. TRAUMA
Remain calm – work at putting on stickers while the medical team does their task
Place your stickers on and hook up wires
Communicate to the trauma team when you are ready to acquire the tracing
When ready tell the trauma team not to move them for 10 seconds

23. RESPIRATORY DISTRESS
The patient in respiratory distress is difficult to obtain an ECG on
You may have to have them in sitting position – just remember to record a comment on the ECG
Place limb leads higher up (Shoulders & Hips)

24. CHEST TUBES Place all electrodes you can without moving bandages
You will probably have to leave leads V5 and V6 off
Take extra precautions around the chest tube. Seek help if it appears to be loose.

25. ACUTE MYOCARDIAL INFARCTION
Remain calm
Leave stickers on if you will be doing serials ECG’s. This will accurately measure changes due to MI and not movement

26. PSYCHIATRIC Be very reassuring when it comes to explaining the exam
Explain the test in layman terms
Never use the word “electro”
Always call an ECG a “Cardiogram” or Heart Tracing
ECG sounds like ECT (shock therapy)

27. REVIEW QUIZ!
Thank you for your time.