Transcript Performing 12 Lead EKGs

Performing 12 Lead EKGs
Emergency Department
Union Hospital
Contents
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Overview
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Management Steps
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Technique
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Clinical Competency Form
Overview
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PERFORMING A 12 LEAD
Good EKG technique is important for achieving the best
result quality.
Check the patient is comfortable, relaxed and reassured
that the procedure is painless. Each time the heart
muscle contracts it generates a voltage pulse. These
heart voltages are picked up by electrodes placed on
the patient’s skin, but when muscles contract, a
voltage pulse also appears, masking the heart
voltages that are recorded by the EKG machine.
Good technique on your part will help the patient relax.
Preparation of the Patient
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Electrode placement can significantly affect the gravity
and slope of the EKG wave form.
Ensure limb leads are attached so that the patient
remains relaxed.
Chest lead placement is very important as the
incorrect intercostal space can alter the EKG pattern.
V1 and V2 are positioned in the fourth intercostal
space on the right and left side of the sternum
respectively. V4 is positioned in the fifth intercostal
space in the mid-clavicular line. V3 is positioned half
way between V2 and V4 following the same line. V6 is
positioned in the fifth intercostal space in the mid
axillary line. V5 is positioned half way between V4
and V6 in a straight line.
Performing an EKG
Press
 M Menu
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D Directory
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A Add a new patient
Performing an EKG
Enter Demographics
 Department: ER
 Last Name: Doe
 First Name: John L
 REQ#: Leave Blank
 MR#: 6 digit number
 Hospital #: 8 digit number
 Chief Complaint: Chest Pain
 Age: 99
 Sex: Press M or F
 Attend MD: Blank
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Order MD: Blank
Review MD: DR. seeing
patient
Tech: Initials- First, middle,
last name
Room: Tx 5
Comment: Blank
Priority: Stat
DOB: 2 digit month SPACE 2
digit day SPACE 4 digit year.
Press left arrow until back to
main screen.
Rhythm Strip
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Change speed on cart by pressing the #7 mm/s. The
speed indicator is located in the bottom right of the
screen. Default speed is 25mm/s.
 Press the #7 mm/s once to change from 25 mm/s to
50 mm/s.
 Press the #3 to change the viewed leads from all to
V123.
 Press the rhythm button. Done.
 Change setting back to default press #7mm/s until the
indicator reads 25mm/s. Press #5 to change leads
back to normal ECG. You can also reset by powering
machine off.
LIMB LEADS
EKG Problems
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Many of the common problems met in
taking EKG’s are due to placement or
application. Most symptoms of problem
EKG’s fall into one or more of the
following categories.
Powerline(AC Interference)
 Wandering Baseline
 Muscle-somatic tremor
 Intermittent or jittery waveform
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Technique
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POWER LINE(AC INTERFERENCE)
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Common causes
Nearby electrical appliances, power cords near the
patient
 Improper grounding of electrical appliances in the
area.
 Loose connections.
 Insufficient skin preparation.
 Dry electrodes.
 Patient touching metal part of bed.
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POWER LINE(AC INTERFERENCE)
Technique
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TO REDUCE INTERFERENCE:
Do not touch electrode during recording.
 Make sure patient is not touching wall or
metal part of bed.
 Check EKG technique on the arms or chest
leads electrodes. If interference is on all
your leads the interference is usually from
test location.
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Technique
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BASELINE WANDER
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A slow upward or downward motion of any or all
lead tracings.
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COMMON CAUSES:
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Poor electrode location.
Unnecessary movement of patient.
Excessive moisture/hair on skin.
To reduce Baseline Wander:
Have patient relaxed.
Arrange patient cable so there is no pull on the lead
wires.
Check for secure application of electrodes.
Discourage excessive movement during test.
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WANDERING BASELINE
Technique
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TREMOR
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Tremor is identified by a fuzzy, totally
irregular baseline.
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COMMON CAUSES:
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A tense patient.
Uncomfortable positioning of your patient.
 To Reduce Tremor:
 Make sure patient is comfortable.
 Keep patient as quiet as possible.
 Check electrodes are making firm contact.
TREMOR OR MUSCLE ARTIFCT
Technique
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INTERMITTENT OR JITTERY WAVEFORM
Irregular movement of the baseline up or down with
no apparent regularity called the jitters. It may have
spikes or interruptions in the recording.
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COMMON CAUSES:
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Loose connections.
Broken lead wires.
Dry electrodes.
Muscle tension or movement.
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TO REDUCE INTERMITTENT OR JITTERY WAVEFORM
Check all connections.
If jitters in 2 limb leads or one or two chest leads, check EKG
technique.
Test lead wires by jiggling them and watching for effect on
EKG.
Reapply electrodes.
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INTERMITTENT OR JITTERY WAVEFORM
Tracemaster (old EKG’s)
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Password:0670
 Enter
 F2
 Location 635
 Tab
 ID:MRN
 Enter
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If patient has had an old
EKG in this system the
most recent will be
highlighted.
 F2 to print
 Print to ……site
 Enter
Site: (00)
 F5 to accept
 Print report 12 lead+ RS
 Enter
CLINICAL COMPETENCY FORM
PERFORMING 12 LEAD EKG’S
Achieved
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Explains the procedure to the patient or assessor
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Prepares skin for electrode placement
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Attaches electrodes at appropriate sites
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Obtains a 12 lead EKG
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Obtain rhythm strip
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Changes EKG paper
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Store/Print/Edit EKG from Pyramis
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Retrieve prior EKG’s
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Able to perform STAT EKG in 10 minutes.
Name_____________________Date:_______
Assessor______________________
Not Achieved