Administering an

Electrocardiogram (ECG)
Equipment Needed
● Twelve-lead ECG machine with charged battery, cables and leads, graph paper
● Disposable electrodes (12)
● Electrode paste or gel
● Alcohol wipes
● Pillows
● Sheet or drape
● Towel and washcloth

Assessment
1. Assess age, gender, and current medication history for any medications with possible cardiac
or hemodynamic effects. Gather other data that may be required by unit/institution protocol
(height, weight, recent blood pressure, operator identification).
Reference standards are tailored to age and gender. Some medications cause
abnormalities inportions of the ECG complex that must be recognized as medication
effect.
2. Determine that the client is able to tolerate a supine position and that adequate exposure of
chest and limbs is possible for electrode placement.
Correct siting of electrodes is enhanced by comfortable, stable position.
3. Determine presence of neck, arm, jaw, or other pain with possible cardiac origin.
Chest or other pain may provide additional information useful in serial comparison
of ECGs.
4. Assess client need for information about the procedure purpose and requirements and ability
to cooperate: that client should lie still and refrainfrom talking, electrode attachment, procedure
lasts only a few minutes and is painless.
Anxiety may be relieved by simple explanation of intent, duration, and purpose.

Diagnosis
● Knowledge Deficit regarding the ECG procedure
● Anxiety related to the procedure or to the diagnosis and treatment
● Decreased Cardiac Output

Planning
● The client will be able to cooperate with procedure.
● The client will not be anxious.
● The client will be able to describe the reason for the ECG.

Implementation

Nursing Procedure 2 1 0
 NURSING ACTION

1. Wash hands.

2. Close door and curtains.

3. Explain the procedure and rationale for ECG.

4. Bring ECG machine to the bedside an open electrode

packages. Since operations requirements are different for
older and newer equipment, review the manufacturer’s
Instructions before proceeding.

5. Enter all demographic data into the machine

6. Position the client in a supine and relaxed position and

drape with a sheet.

7. Remove moisture, oil, and excess hair from site at

electrode sites.

8. Apply electrode paste and attach electrodes to the chest:

V1—4th intercostal space (ICS) at right sterna border.
Females: Choose a site as close to standard position as possible.
V2—4th ICS at left sternal border.
V3—Midway between V2 and V4
V4—5th ICS at midclavicular line.
V5—Left anterior axillary line at level of V4
horizontally.
V6—Left midaxillary line at level of V4 horizontally

● Attach lead wires to electrodes.

● Obtain tracing by following the instructions from the

physician or qualified for the practitioner. In general, a
2.5 second strip from each lead, plus
A second rhythm strip is required.

● Inspect tracing for adequate quality.

● Remove leads and electrodes.Wipe paste from skin.

● Notify physician or qualified practitioner of

abnormalities.
 ● Wash hands.

● Return machine and replace supplies.

Evaluation
● The client tolerated the ECG procedure.
● The client is able to state purpose of ECG.
● The client is free of chest pain or other cardiac complaints.
● An accurate tracing was obtained for analysis.

Documentation

● Note the date and time of the ECG.

● Describe the reason for the ECG and any significant findings.
● Record the time the tracing results were reported to the physician or qualified
practitioner.

COMPUTATION OF GRADES

STEP 1: Get the sum of all the points for the entire procedure

STEP 2: Use the formula below to get the final grade for the particular competency
Checklist

FORMULA: RAW SCORE / PERFECT SCORE X 60 + 40 = FINAL GRADE

Evaluated by: Conforme:

Signature over Printed Name Signature over printed name

Clinical Instructor Student

Date: ___________________ Date: ___________________

REMARKS:
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