MACP 323 - CH49 P49-1

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Materials: Patient chart/progress note, electrocardiograph, ECG paper, electrodes, electrolyte preparation, wires, patient gown, drape, blanket, pillows, gauze pads, alcohol, moist towel, scissors for trimming hair (if needed)

Obtaining an ECG PROCEDURE 49-1

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Procedure Goal: To obtain a graphic representation of the electrical activity of a patient’s heart

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OSHA Guideline: Wash hands, have a biohazard waste bin and sharps container nearby for use, and use antiseptic spray

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Step 18

Disconnect the patient from the machine.

Step 28

Clean and disinfect the equipment and the room according to OSHA guidelines.

Step 13

Check all electrodes and wires for proper placement and connection; drape wires over the patient to avoid creating tension on the electrodes, which can result in artifacts.

Step 3

Identify the patient, introduce yourself, and explain the procedure.

Step 25

Wash your hands.

Step 20

Disconnect the wires from the electrodes and remove the electrodes from the patient.

Step 4

Drop the object directly into an approved puncture-proof container for sharps. Engage safety device, if indicated.

Step 19

Remove the tracing from the machine and label it with the patient’s name, the date, and your initials if these do not print out with the tracing.

Step 27

Properly dispose of used materials and disposable electrodes.

Step 24

Assist the patient in dressing, if necessary, or allow the patient privacy to dress.

Step 22

Assist the patient into a sitting position.

Step 10

Apply electrodes to fleshy portions of the limbs, making sure the electrodes on one arm and leg are placed similarly to those on the other arm and leg. Attach electrodes to areas that are not bony or muscular. The arm lead tabs on the electrode point downward and the electrode tabs for the leg leads point upward. Peel off the backings of the disposable electrodes and press them into place.

Step 2

Turn on the electrocardiograph. Ensure that there is an adequate paper supply and that the machine inspection is up to date.

Step 12

Attach wires and cables, making sure all wire tips follow the patient’s body contours.

Step 17

Correct problems and repeat any tracings that are not clear.

Step 1

Gather equipment and supplies.

Step 15

Remind the patient to lie quietly, and run the ECG.

Step 21

Clean the patient’s skin with a moist towel.

Step 5

Ask the patient to disrobe from the waist up and remove jewelry, socks or stockings, bra, and shoes. If the electrodes will be placed on the patient’s legs, have the patient roll up their pant legs. Sometimes the electrodes are placed on the sides of the lower abdomen—check the manufacturer’s instructions. Provide a gown for patients and instruct them to wear the gown with the opening in front.

Step 14

Enter the patient data into the electrocardiograph. If standardization is needed, check the manufacturer’s instructions.

Step 11

Apply the precordial electrodes at specified locations on the chest. Precordial electrode tabs point downward.

Step 6

Assist the patient onto the table and into a supine position. Cover the patient with a drape (and a blanket if the room is cool). If the patient experiences difficulty breathing or cannot tolerate lying flat, use a Fowler’s or semi-Fowler’s position, adjusting with pillows under the head and knees for comfort if needed. Document any modifications to the patient position on the ECG report.

Step 8

Wash the patient’s skin, using gauze pads moistened with alcohol. If needed, rub it vigorously with dry gauze pads to promote better contact of the electrodes.

Step 16

Check tracings for artifacts.

Step 4

Wash your hands.

Step 26

Record the procedure in the patient’s chart.

Step 23

Allow a moment for rest and then assist the patient from the table.

Step 9

If the patient’s leg or chest hair is dense, use a small pair of scissors or clippers to closely trim the hair where you will attach the electrode. (Shaving is generally not allowed because of the risk of bleeding and infection. Follow the procedure specified at your facility.)

step 7

Tell the patient to rest quietly and breathe normally. Explain the importance of lying still to prevent false readings.