Electrocardiography A 12-lead electrocardiogram is the standard form of electrocardiogram used to diagnose cardiac rhythm disturbances and many types

of cardiac problems such as myocardial ischemia or infarction. It may reveal other cardiac structural or functional abnormalities such as hypertrophy, certain drug effects, and electrolyte abnormalities; however, other modalities exist for diagnosis of these types of abnormalities. Purpose: 1. Record the hearts electrical activity. 2. Diagnose cardiac disorders. 3. Evaluate effectiveness of medical management. 4. Identify abnormalities in cardiac rhythm and conduction. Nursing Considerations: 1. Gain the clients cooperation so he will lie still and be relaxed in order to minimize artifact caused by muscle movement. 2. Palpation of ribs and intercostal spaces and visual references to clavicle and axilla are necessary to place electrodes correctly. 3. Dry diaphoretic skin before the ECG since it may hinder attachment of electrodes; even one loose lead can cause the tracing to be faulty. 4. Shave body hair in any area where it prevents good skin contact of the electrode. 5. Attach the lead wire to button-type electrodes first so you do not have to press it into the client. 6. Note the date and time of any cardiac medications given. 7. Instruct the client to lie still, avoid movement, coughing or talking while ECG is recording to avoid artifacts. Procedure: 1. Verify the physicians order. Gather equipment. Wash hands. Identify client and introduce elf. Explain procedure. Position comfortably on bed. Ensure privacy. 2. Expose peripheral lead attachment sites, apply a thin layer of electrode gel on the inner aspects of each of the clients limbs, and attach respective leads ensuring good contact of the sin and the metal surfaces. Attach corresponding electrode wires to the peripheral leads. 3. Expose chest are and locate chest lead attachment sites, applying a thin layer of electrode gel in each of them. V1 4th ICS, RSB V2 4th ICS, LSB V3 between V2 and V4 V4 5th ICS, MCL V5 5th ICS, AAL V6 5th ICS, MAL 4. Apply proper suction in each chest lead, ensuring that there is firm contact between skin and metal. Attach corresponding electrode wires to chest leads, following color codes or electrode labels for accuracy. 5. Drape client, lightly covering chest area with a sheet without dislodging any chest leads. 6. Instruct client to remain immobile and quiet for the duration of the recording. Start recording. 7. Inform the client if recording is done. Remove all leads. 8. Offer assistance to client as he dresses and/ or gets up from the bed. 9. Thank the client and give instructions. Document the date and time of recording.

Prepared by: Apal, Janoelan Balistoy, Kathleen Castillano, Yvonne Rossini Empiales, Vina Jane BSN 4 - NB