Electrocardiography (ECG)

UNCONTROLLED WHEN PRINTED

Indications

To perform and transmit a 12-lead ECG to look for signs of cardiac dysrhythmia or acute coronary syndrome.

Contraindications

Patient Factors & Considerations

Patient age and gender should be entered for accuracy of ECG diagnosis
Ensure frequency is 0.05 – 40Hz and paper speed is 25mm/sec for diagnostic quality.
Female patients: place pre-cordial electrodes under rather than on the breast.
Leave electrodes in situ to facilitate the comparison of serial 12-Lead ECGs.
Multiple 12-lead ECG’s are advocated and may capture evolving changes

Patient name must be included in ALL transmitted ECG's
Do not transmit ECG’s unless monitor reads: “ACUTE MI” / "Meets STEMI criteria" OR the patient meets the inclusion criteria as per Acute Coronary Syndrome CPG; consult with CSPSOC if necessary.
When transmitting, ensure that the correct ECG is selected. The default setting always selects the initial ECG acquired; manual override is required for subsequent ECG acquisitions/D-ECG's.

Procedure

All relevant infection control methods to be utilised.
Prepare patient’s skin at electrode sites: clip hair, wash and dry (if required).
Position patient supine or semi-recumbent.
Attach electrodes and cables to patient:

RA (Right arm)	Right wrist preferred (or mid-arm/shoulder)
LA (Left arm)	Left wrist preferred (or mid-arm/shoulder)
RL (Right leg)	Right ankle preferred (or hip)
LL (Left leg)	Left ankle preferred (or hip)
V₁ (Vector 1)	4th intercostal space, right of sternum
V₂ (Vector 2)	4th intercostal space, left of sternum
V₃ (Vector 3)	In between V2 and V4
V₄ (Vector 4)	5th intercostal space, left midclavicular line
V₅ (Vector 5)	In between V4 and V6
V₆ (Vector 6)	5th intercostal space, anterior axilla.

Acquiring ECG

If possible, ask the patients to hold their breath whilst ECG is obtained.
Press the softkey [D-ECG]. A preview of all 12 ECG leads is displayed on the screen.
Check in the preview if all ECG leads are written.
Check in the preview if the signal quality of the leads is acceptable.
If the signal quality of one or several leads is poor, check electrode contact and electrode positioning and take appropriate measures.
When the message "Ready for D-ECG" appears in the preview, press the softkey [Start]. The ECG recorded up to this moment is discontinued and saved.
The configuration dialogue for entering the patient’s sex and age opens.
The configuration dialogue has to be confirmed with the softkey [OK].
With the softkey [Print] the D-ECG is printed out for diagnosis

Transmitting ECG

With the softkey [Send] it is sent
To run another preview on the monitor, press the softkey [Cont.] or press the softkey [Cancel] to quit the preview and to switch to monitoring mode.

On-Screen Preview Display when performing D-ECG (12-lead ECG)