Republic of the Philippines

PAMANTASAN NG LUNGSOD NG MAYNILA

(University of the City of Manila)
General Luna Street corner Muralla Street
Intramuros, Manila

COLLEGE OF NURSING
(Dalubhasaan ng Narsing)

INTENSIVE CARE NURSING – SKILLS CHECKLIST

12 LEAD ELECTROCARDIOGRAM: LEAD PLACEMENTS, READING AND

INTERPRETATION

PURPOSE:
It is the process of recording the electrical activity of the heart over a period of time using
electrodes placed over the skin. It is a tool to diagnose certain cardiac problems like
ARRHYTHMIAS (Abnormal Heart Rhythm) MYOCARDIAL INFARCTION (Heart Attack)

ECG PLACEMENTS:
A. Limb Leads – these are 3 bipolar leads connected to the arms and legs of the patient
• Lead I, AVR – placed at right arm
• Lead II, AVL – placed at left arm
• Lead III, AVF – placed at left leg
• Neutralizer – placed at right leg
B. Chest (Precordial) Leads – these are 6 unipolar leads connected to the patient’s anterior
chest
• V1 – 4th Intercoastal Space, Right, Sternal Border
• V2 – 4th Intercoastal Space, Left, Sternal Border
• V3 – midway between V2 and V4
• V4 – 5th Intercoastal Space, Left, Midclavicular Line
• V5 – 5th Intercoastal Space, Left, Anterior Axillary Line
• V6 – 5th Intercoastal Space, Left, MidAxillary Line

BASIC PRINCIPLES:
P wave
• Indicates atrial depolarization, or contraction of the atrium.
• Normal duration is not longer than 0.11 seconds (less than 3 small squares)
QRS complex
• Indicates ventricular depolarization, or contraction of the ventricles.
T wave
• Indicates ventricular repolarization
• Not more that 5 mm in amplitude in standard leads and 10 mm in precordial leads
• Rounded and asymmetrical
U wave
 • Commonly not seen, represents repolarization in the purkinje fibers; may be pathological
like in hypokalemia
ST segment
• Indicates early ventricular repolarization
• Normally not depressed more than 0.5 mm
PR interval
• Indicates AV conduction time
• Duration time is 0.12 to 0.20 seconds
QT interval
• Measured from the Q to the end of the T.
• Represents ventricular depolarization and repolarization (sodium influx and potassium
efflux)

INDICATIONS:
 Myocardial Infarction and other types of Coronary Artery Disease such as Angina
 Cardiac Dysrhythmias
 Cardiac Enlargement
 Electrolyte Disturbances (Calcium, Potassium, Magnesium & Phosphorus)
 Inflammatory Diseases of the Heart

EQUIPMENT:
 12 Lead ECG Machine

STEPS/PROCEDURE RATIONALE/PERFORMANCE

1. Verify doctor’s order for a 12 Lead ECG

2. Gather/Check all necessary equipment/s available
3. Confirm the correct patient for ECG, introduce
yourself.

4. Obtain inform consent.

Inform the patient regarding the procedure like the
indication and possible complication (pain sensation
upon removal of the chest leads)
5. Have the patient remove all metal objects in the body.
6. Place the patient on supine/semi-fowler’s position.
7. Enter the patient’s demographics on the ECG
machine
8. Place the ECG Leads

A. Limb Leads
1. Lead I, AVR – placed at right arm
2. Lead II, AVL – placed at left arm
3. Lead III, AVF – placed at left leg
4. Neutralizer – placed at right leg
 B. Chest Leads
1. V1 – 4th Intercoastal Space, Right, Sternal Border
2. V2 – 4th Intercoastal Space, Left, Sternal Border
3. V3 – midway between V2 and V4
4. V4 – 5th Intercoastal Space, Left, Midclavicular
Line
5. V5 – 5th Intercoastal Space, Left, Anterior
Axillary Line
6. V6 – 5th Intercoastal Space, MidAxillary Line

9. Ask the patient to remain still and quiet for 10-15

seconds
10. Run the 12 Lead ECG by pressing
READ/GO/ANALYZE button on the machine
11. Save/ Print he ECG tracing
12. If satisfactory ECG obtained, (check for grounded
tracings and artifacts) remove the leads from the
patient’s body.
13. Performed hand hygiene
14. ECG Interpretation:
a. Check the rhythm if it is regular or irregular rhythm.
Compare the distance between R waves

b. Calculate the heart rate from the six second strip.

Note:
 If the rhythm is regular, the heart rate is 300 divided
by the number of large squares between two QRS
Complex
 If the rhythm is irregular, count the number of R
waves in a 6 second strip and multiply by ten

c. Interpret the rhythm and refer to the doctor the

ECG tracing.

SCORE:

GRADING:
2 POINTS – Correct/Complete Rationale
1 POINT - Incomplete Rationale
0 POINT - Incorrect Rationale

TOTAL: 50 POINTS = 100% (Score / 50) x 100 = Score in Percentage

References:
 Hudak,et al. Critical Care Nursing: A Holistic Approach
 Schumacher & Chernecky. Critical Care and Emergency Nursing
 Lippincott. Manual of Nursing Practice
 Emergency Nurses Association of the Philippines. BLS & ACLS Handbook

Prepared By: Prof. Aris S. Santos, RN, RM

For AY 2021-2022, First Semester

Total score: _____________

I fully understand how I was graded for this skill and it was properly explained to me.
______________________________
Student’s FULLNAME & Signature
Date: ______________

I have explained and discussed how I have graded my student for this particular skill.
___________________________
Clinical Instructor FULLNAME & Signature
Date: _________