ECG TRAINING MODULE 2 BY BRAD CHAPMAN RCT. OBJECTIVES 1. PATIENT APPROACH 2. LEAD PLACEMENT 3. ARTIFACT 4. SPECIAL NEEDS PATIENTS.

ECG TRAINING MODULE 2ECG TRAINING MODULE 2

BYBY

BRAD CHAPMAN RCTBRAD CHAPMAN RCT

OBJECTIVESOBJECTIVES

1.1. PATIENT APPROACHPATIENT APPROACH

2.2. LEAD PLACEMENTLEAD PLACEMENT

3.3. ARTIFACTARTIFACT

4.4. SPECIAL NEEDS PATIENTSSPECIAL NEEDS PATIENTS

The ApproachThe Approach

Enter to the left hand side of the patientEnter to the left hand side of the patientEnsure them that this test doesn't hurtEnsure them that this test doesn't hurtMake sure curtain is pulled across for the Make sure curtain is pulled across for the

womenwomenAsk the Men if they want the curtain pulled Ask the Men if they want the curtain pulled

– most won't but occasional one will– most won't but occasional one will

Patient PreparationPatient Preparation

Tell patient that you are going to place Tell patient that you are going to place stickers on them and then connect some stickers on them and then connect some wireswires

Start by placing a sticker on either the Start by placing a sticker on either the arms or legs first – this helps to show that arms or legs first – this helps to show that this test is non-invasive and helps to this test is non-invasive and helps to relieve anxietyrelieve anxiety

Placement of LeadsPlacement of Leads

Find the first intercoastal space by moving a Find the first intercoastal space by moving a finger down the right collar bone towards the finger down the right collar bone towards the sternum. Stop a ½ “ before the sternumsternum. Stop a ½ “ before the sternum

Rock fingers down chest counting the intercostal Rock fingers down chest counting the intercostal spacesspaces

Count down to the 4Count down to the 4thth intercostal space intercostal space Place a sticker therePlace a sticker there Repeat process on the other side of the sternumRepeat process on the other side of the sternum

Placement of leadsPlacement of leads

Draw a vertical line from mid-clavicular to Draw a vertical line from mid-clavicular to under the breast and place a sticker. This under the breast and place a sticker. This will be V4.will be V4. Place sticker in between v2 and v4 Place sticker in between v2 and v4

This sticker would be on a diagonal plane This sticker would be on a diagonal plane between v2 and v4between v2 and v4

Visual drop a horizontal line straight line Visual drop a horizontal line straight line down from v4 to mid-auxilla and place a down from v4 to mid-auxilla and place a sticker (v6)sticker (v6)

Place a sticker between v4 and v6 – this will Place a sticker between v4 and v6 – this will be your v5 leadbe your v5 lead

Chest Lead PlacementChest Lead Placement

All chest leads are labelled v1, v2, v3,...v6.All chest leads are labelled v1, v2, v3,...v6.All leads are color coded.All leads are color coded.Chest leads are Chest leads are

RedRedYellowYellowGreenGreenBlueBlueOrangeOrangePurplePurple

Easy to rememberEasy to remember

Stop LightStop LightRed, Yellow, GreenRed, Yellow, Green

BOPBOP Blue, Orange, Blue, Orange, PurplePurple

ArtifactArtifactThere are different types of artifactThere are different types of artifact

Somatic tremors (muscle artifact) – most Somatic tremors (muscle artifact) – most commoncommon

Wandering baselineWandering baseline

AC interferenceAC interference

Somatic Tremors (Muscle artifact)Somatic Tremors (Muscle artifact)CAUSECAUSE

Most common type of artifactMost common type of artifact Caused by patient moving limbs, fingers, nervous, restless, or Caused by patient moving limbs, fingers, nervous, restless, or

anxiousanxious

REMEDYREMEDY

Try to have the patient relax and hold stillTry to have the patient relax and hold still Try talking in a calmingTry talking in a calming voice while doing the tracingvoice while doing the tracing Move limb stickers higherMove limb stickers higher up the limbup the limb

Wandering BaselineWandering Baseline

CAUSECAUSE

Patient is moving or stickers are not making a good Patient is moving or stickers are not making a good contactcontact

Cables may be dangling or swayingCables may be dangling or swaying

REMEDYREMEDY

Place a towel on chest leadsPlace a towel on chest leads to weight them down to weight them down Apply pressure to leadApply pressure to leadwith a towelwith a towel

AC InterferenceAC Interference Consistent and regular saw tooth patternConsistent and regular saw tooth pattern

REMEDYREMEDY

Turn off all cell phones and other electronic devices Turn off all cell phones and other electronic devices (possibly lights)(possibly lights)

Unplug electric bedUnplug electric bed TENS machines mustTENS machines must be turned off to do ECGbe turned off to do ECG Place ECG machine further Place ECG machine further away from ventilators, IV pumpsaway from ventilators, IV pumps X-Ray equipmentX-Ray equipment Radio and TVRadio and TV

Where is that Artifact coming from?Where is that Artifact coming from?

If there is artifact in If there is artifact in Check this connectionCheck this connectionthese leadsthese leads

Lead I and IILead I and II RARA Lead I and IIILead I and III LALA Lead II and IIILead II and III LLLL

OROR

Tap on or shake the limb lead and see where the Tap on or shake the limb lead and see where the interference is coming frominterference is coming from

Special Needs PatientSpecial Needs Patient

Amputees Amputees BurnsBurns TremorsTremors PaediatricsPaediatrics WheelchairWheelchair TraumaTrauma SOBSOB Acute MIAcute MI PsychiatricPsychiatric

AMPUTEESAMPUTEES

Place lead further up the limb or even on Place lead further up the limb or even on the hip or shoulderthe hip or shoulder

You can put both leg leads on the left leg You can put both leg leads on the left leg as long as the left lead is higher up the leg as long as the left lead is higher up the leg then the right leg leadthen the right leg lead

BURNSBURNS Place leads on parts of the skin that are not burntPlace leads on parts of the skin that are not burnt Do not remove any clothing that is stuck to the skinDo not remove any clothing that is stuck to the skin Take alligator clip off the end of the lead, clean with alcohol and Take alligator clip off the end of the lead, clean with alcohol and

hold the tip of the lead on the skin lightlyhold the tip of the lead on the skin lightly

TREMORSTREMORS

Parkinson’s diseaseParkinson’s diseasePlace hands underneath the buttocksPlace hands underneath the buttocksPlace electrodes on Hips or ShouldersPlace electrodes on Hips or ShouldersAdd extra pillow under kneesAdd extra pillow under knees

PEDIATRICSPEDIATRICSGetting small children to hold still during an Getting small children to hold still during an

ECG may be challengingECG may be challengingDistraction with toys or MusicDistraction with toys or MusicYoung infants, place stickers on then wrap in a Young infants, place stickers on then wrap in a

blanketblanket

WHEELCHAIRWHEELCHAIRAssist to transfer to bedAssist to transfer to bed If they can’t move to bed – do ECG in the If they can’t move to bed – do ECG in the

chairchairRecord on the ECG that done while sitting Record on the ECG that done while sitting

up. (Changes the axis of the heart)up. (Changes the axis of the heart)

TRAUMATRAUMA Remain calm – work at putting on stickers while the Remain calm – work at putting on stickers while the

medical team does their taskmedical team does their task Place your stickers on and hook up wiresPlace your stickers on and hook up wires Communicate to the trauma team when you are ready to Communicate to the trauma team when you are ready to

acquire the tracingacquire the tracing When ready tell the trauma team not to move them for When ready tell the trauma team not to move them for

10 seconds10 seconds

RESPIRATORY DISTRESSRESPIRATORY DISTRESS The patient in respiratory distress is difficult to The patient in respiratory distress is difficult to

obtain an ECG onobtain an ECG on You may have to have them in sitting position – You may have to have them in sitting position –

just remember to record a comment on the ECGjust remember to record a comment on the ECG Place limb leads higher up (Shoulders & Hips)Place limb leads higher up (Shoulders & Hips)

CHEST TUBESCHEST TUBES Place all electrodes you can without moving Place all electrodes you can without moving

bandagesbandages You will probably have to leave leads V5 and V6 You will probably have to leave leads V5 and V6

offoff Take extra precautions around the chest tube. Take extra precautions around the chest tube.

Seek help if it appears to be loose.Seek help if it appears to be loose.

ACUTE MYOCARDIAL ACUTE MYOCARDIAL INFARCTIONINFARCTION

Remain calmRemain calmLeave stickers on if you will be doing Leave stickers on if you will be doing

serials ECG’s. This will accurately serials ECG’s. This will accurately measure changes due to MI and not measure changes due to MI and not movementmovement

PSYCHIATRICPSYCHIATRIC Be very reassuring when it comes to explaining the Be very reassuring when it comes to explaining the

examexam Explain the test in layman termsExplain the test in layman terms Never use the word “electro”Never use the word “electro” Always call an ECG a “Cardiogram” or Heart TracingAlways call an ECG a “Cardiogram” or Heart Tracing ECG sounds like ECT (shock therapy)ECG sounds like ECT (shock therapy)

REVIEW QUIZ!REVIEW QUIZ!

Thank you for your time.Thank you for your time.