1. What is EKG( Electrocardiography)/ 12lead
•The electrocardiogram (ECG) is a representation of
the electrical events of the cardiac cycle.
•One of the most valuable frequently used diagnostic
•Electrocardiography displays heart’s electrical
activity as waveforms.
•The 12 lead ECG uses a series of electrodes placed
on extremities and the chest wall to assess the heart
from 12 different views.
2. ECG Leads
• The 12 lead consist of:
– Three Standard limb or
bipolar leads (I, II, III)
utilize three electrodes;
these leads form a
triangle known as
– Three Augmented
unipolar leads (aVR, aVL,
– Six Precordial unipolar
leads (V1, V2, V3, V4, V5,
• ECG Machine
• Conduction gel
• Alcohol swab
Preparation Of Equipment
• Place the ECG machine
close to the client's bed
and plug the cord into the
wall outlet or, batteryoperated, ensure that it is
• Turn on the machine and
input required client
• Check that machine
settings are standard
5. Step by step standard ECG settings;
• Enter menu button by
pressing the knob:
• Rotate knob and
highlight menu blue
light then enter by
6. When you select EKG in menu
11. •Verify the Physician order.
•Indentify the patient according to FH
•Provide privacy and explain the
procedure to the client.
Explain that the test records the heart's
electrical activity and that it may be
repeated at certain intervals. Emphasize
that no electrical current will enter the
body. Tell the client that the test typically
takes about 5 minutes.
12. •Perform hand hygiene.
•Advice the client lie supine position in the
center of the bed with arms at his sides.
You may raise the head of the bed to promote
comfort. Expose the arms and legs and cover
the client appropriately. The arms and legs
should be relaxed to minimize muscle
trembling, which can cause electrical
Make sure the feet are not touching the bed
13. •Select flat, fleshy areas to place the limb lead
electrodes, Avoid muscular and bony areas. If the
client has an amputated limb, choose a site on the
•If an area is excessively hairy, clip it. Clean excess oil
or other substances from the skin with alcohol pad
to enhance electrode contact
•Apply disposable electrodes to the client's wrists
and to the medial aspects of the ankles.
•Expose the client's chest. Put a pre-gelled electrode
at each electrode position. If your client is a woman,
be sure to place the chest electrodes below the
breast tissue. In a large-breasted woman, you may
need to displace the breast tissue laterally.
14. Limb Lead Placement
• Connect the lead wires to the
electrodes. The tip of each
lead wire is lettered and colorcoded for easy identification.
• The red or RA lead wire goes
to the right arm
• The yellow or LA lead wire
goes to left arm
• The black or N/ RL lead wire
goes to right leg
• The green or LL lead wire goes
to left leg
15. Chest lead placement
• V1 ---- Red lead 4th Intercostal
space to the right of the sternum
• V2 ----- Yellow Lead4th
Intercostal space to the left of
• V3 ---- Green Lead Midway
between V2 and V4
• V4 ----- Brown lead 5th
Intercostal space at the
• V5 ----- Black lead Anterior
axillary line at the same level as
• V6 ---- Violet lead Midaxillary
line at the same level as V4 and
16. • Now you ready to begin the
• Ask the patient to lie still and
not to talk , breath normally
and relax when recording ECG
• machines have a display screen
so that you can preview
waveforms before the machine
records them on paper.
• Press the PRINT button.
Observe the tracing quality.
The machine will record all
12 leads automatically,
recording three consecutive
17. •When the machine finishes recording the 12-lead ECG,
remove the electrodes and clean the client's skin
•After disconnecting the lead wires from the electrodes,
CLEAN & DRY the electrodes as per manufacture instruction.
•Assist the client to a comfortable position.
•Ensure the bed is in a low position.
•Remove any remaining equipment and wash your hands.
Label ECG recording with
Medical record no
•Document the procedure in Nurses notes .