The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [464]
Procedure
5 Apply the chest electrodes as described in Figure 12.7. Apply the limb leads proximal to the appropriate wrist and ankle. For advice on placement in females and known cardiac abnormalities please see the Specific patient preparations. To obtain the ECG recording from vertical and horizontal planes (Roberts 2002, E). Following a standard arrangement ensures consistency between recordings and prevents invalid recordings and false diagnosis (SCST 2006, C).
6 Attach the leads from the ECG machine to the electrodes. To obtain the ECG recording (Roberts 2002, E).
7 Check that the leads are connected correctly and to the relevant electrode. To ensure the correct polarity in the ECG recording (Roberts 2002, E).
8 Ensure that the leads are not pulling on the electrodes or lying over each other. Offer the patient a gown or sheet to place over their exposed chest. To reduce electrical artefact and to obtain a good ECG recording (Roberts 2002, E). To promote patient dignity and reduce anxiety (SCST 2006, C).
9 Ask patient to relax and refrain from movement. To obtain the optimal recording by the reduction of artefact from muscular movement (Roberts 2002, E; SCST 2006, C).
10 Encourage the patient to breath normally and not to speak while the trace is being taken. Speaking can alter the recording (Roberts 2002, E).
11 Check that calibration is 10 mm/mV. To ensure standard recording to aid interpretation. E
12 Commence the recording. To obtain ECG. E
13 In the case of artefact or poor recording, check electrodes and connections. To ensure optimal recording (Roberts 2002, E).
14 During the procedure give reassurance to the patient. To ensure the patient feels informed and reassured (Roberts 2002, E).
15 If necessary, record a rhythm strip utilizing leads II and V1. To assist with interpretation if there have been any acute rhythm disturbances. Can also ensure steady baseline (Roberts 2002, E).
16 Detach ECG printout and label with patient’s name, hospital number, date and time. File the ECG recording in the appropriate documentation. To ensure that the ECG is labelled with the correct patient, date and time (NMC 2009, C). To ensure that the recording does not get lost (NMC 2009, C).
Postprocedure
17 Inform patient that the procedure is now finished and help to remove the electrodes. To ensure that the patient can relax and that the electrodes are removed. E
18 Wash hands using bactericidal soap and water or bactericidal alcohol handrub, and dry. To minimize the risk of infection (Fraise and Bradley 2009, E).
19 Inform nursing and medical staff that the ECG has been completed and its location. To enable relevant nursing and medical staff to use the ECG data in their care planning and treatment (NMC 2008a, C).
20 Clean the ECG machine following manufacturer’s advice after patient use and return it to its storage place and plug it in to keep the battery fully charged. The ECG machine forms part of a ward’s emergency equipment and should always be available and in good working order with a charged battery for use in an emergency (Metcalfe 2000, E).
Problem-solving table 12.2 Prevention and resolution (Procedure guideline 12.2)
Postprocedural considerations
Immediate care
Any changes on the ECG that might require urgent medical attention should be identified and advice sought from a senior member of staff. If the patient has any cardiac symptoms at the time of recording, such as chest pain or palpitations, then this should be noted on the tracing and brought to the immediate attention of a doctor (SCST 2006). Examples of normal and some important abnormal ECG tracings are shown in Figure 12.8.
Figure 12.8 Normal and abnormal ECG tracings.
Reproduced from Tortora and Derrickson (2009).
Documentation
Once the nurse has recorded the ECG, this should be reviewed by an appropriate member of the medical team,