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NURSING PROCEDURE OBTAIN 12 LEAD ECG
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NURSING PROCEDURE OBTAIN 12 LEAD ECG

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  • 1. What is EKG( Electrocardiography)/ 12lead ECG •The electrocardiogram (ECG) is a representation of the electrical events of the cardiac cycle. •One of the most valuable frequently used diagnostic tool. •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 Einthoven's Triangle. – Three Augmented unipolar leads (aVR, aVL, aVF). – Six Precordial unipolar leads (V1, V2, V3, V4, V5, V6).
  • 3. Equipment’s • ECG Machine • Recording Paper • Electrodes • Conduction gel Optional • Clippers • Alcohol swab or pad
  • 4. Procedure 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 functioning. • Turn on the machine and input required client information. • Check that machine settings are standard
  • 5. Step by step standard ECG settings; Steps: • Enter menu button by pressing the knob: EKG PRINT SETUP EXIT • Rotate knob and highlight menu blue light then enter by press knob
  • 6. When you select EKG in menu • EKG LEAD SPEED GAIN FILTER MUSLE BASELINE NOTCH RETURN
  • 7. Cont’d LEAD 3 × 1 3× 2 6×1 6×2 RETURN
  • 8. Cont’d Speed 12.5 mm/sec 25.0 mm/sec 50.0 mm/sec RETURN
  • 9. Cont’d GAIN 5 mm/mV 10 mm/ mV 15 mm/ mV RETURN
  • 10. Cont’d • PRINT  MODE MONITOR  DIAGNOSIS FREEZE  RETURN WAVE SIZE 2-9 BRIGHTNESS RECORDS RETURN
  • 11. •Verify the Physician order. •Indentify the patient according to FH policy. •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 interference. Make sure the feet are not touching the bed board.
  • 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 stump. •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 the sternum • V3 ---- Green Lead Midway between V2 and V4 • V4 ----- Brown lead 5th Intercostal space at the midclavicular line • V5 ----- Black lead Anterior axillary line at the same level as V4 • V6 ---- Violet lead Midaxillary line at the same level as V4 and V5
  • 16. • Now you ready to begin the recording • 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 leads simultaneously.
  • 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 Patient’s name Medical record no Date Time Signature •Document the procedure in Nurses notes .