Performing an ECG

Introduction

• Wash hands; Introduce self; Patient’s name, DOB and wrist band; Explain procedure and obtain consent
• Chaperone if female patient
• Lie patient flat, expose chest 
• If needed, shave skin or wipe with alcohol wipe

Apply leads

Apply limb leads 

 

Red	Right arm, just proximal to wrist
Yellow	Left arm, just proximal to wrist
Green	Left leg, just proximal to ankle
Black	Right leg, just proximal to ankle

Apply chest leads

V1	4th intercostal space, right sternal edge
V2	4th intercostal space, left sternal edge
V3	Equidistant between V2 and V4
V4	5th intercostal space, midclavicular line
V5	Anterior axillary line in same horizontal plane as V4
V6	Midaxillary line in same horizontal plane as V4 and V5

NB: if female, electrodes should go under the breast (not on top).

Using the machine

• Calibrate ECG machine to: speed = 25mm/s; voltage = 10mm/mV
• Enter the patient details (name, DOB, hospital number, sex etc.) and ECG details (date, time)
• When ready, ask the patient to stay as still as possible and not speak
• Press the button to begin the trace (‘auto’) 
• Check the printed trace to ensure:
  • Calibration is correct (paper speed 25mm/s; 1mV calibration deflection is 2 large squares in height)
  • All leads are working 
  • Clear traces can be seen

To complete

• Remove the leads and stickers
• Thank patient and restore clothing
• Label the ECG if the patient’s details are not printed 
• Document procedure in patient’s notes