An electrocardiogram (ECG or EKG) records the electrical activity of the heart. A 12-lead ECG uses electrodes placed on the wrists, ankles, and chest to assess the heart from 12 different views. It is a valuable diagnostic tool that displays the heart's electrical activity as waveforms. The procedure involves preparing the ECG machine, attaching electrodes to the patient's limbs and chest in specific positions, recording the 12 leads automatically, and removing the electrodes after.

2. 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.

3. 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).

4. Equipment’s
• ECG Machine
• Recording
Paper
• Electrodes
• Conduction gel
Optional
• Clippers
• Alcohol swab
or pad

5. 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

6. 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

7. When you select EKG in menu
• EKG
LEAD
SPEED
GAIN
FILTER
MUSLE
BASELINE
NOTCH
RETURN

8. Cont’d
LEAD
3 × 1
3× 2
6×1
6×2
RETURN

9. Cont’d
Speed
12.5 mm/sec
25.0 mm/sec
50.0 mm/sec
RETURN

10. Cont’d
GAIN
5 mm/mV
10 mm/ mV
15 mm/ mV
RETURN

11. Cont’d
• PRINT
 MODE
MONITOR
 DIAGNOSIS
FREEZE
 RETURN
WAVE SIZE
2-9
BRIGHTNESS
RECORDS
RETURN

12. •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.

13. •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.

14. •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.

15. 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

16. 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

17. • 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.

18. •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 .