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P R O C E D U R E 49-1 Obtaining an ECG

Goal
To obtain a graphic representation of the electrical activity of a patient’s heart

OSHA Guidelines

Materials
Patient chart/progress note, electrocardiograph, ECG paper, electrodes, electrolyte preparation, wires, patient gown,
drape, blanket, pillows, gauze pads, alcohol, moist towel, and scissors for trimming hair (if needed)

Method

Step Points Points

Number Procedure Time Limit: 15 minutes Possible Earned
1. Turn on the electrocardiograph. Ensure that there is an adequate paper supply and 3
that the machine inspection is up to date.
2. Identify the patient, introduce yourself, and explain the procedure. 3
3. Wash your hands. 3
4. Ask the patient to disrobe from the waist up and remove jewelry, socks or stockings, 3
bra, and shoes. If the electrodes will be placed on the patient’s legs, have the
patient roll up his or her pant legs. Sometimes the electrodes are placed on the
sides of the lower abdomen—check the manufacturer’s instructions. Provide a gown
if the patient is female, and instruct her to wear the gown with the opening in front.
5. Assist the patient onto the table and into a supine position. Cover the patient with 3
a drape (and a blanket if the room is cool). If the patient experiences difficulty
breathing or cannot tolerate lying flat, use a Fowler’s or semi-Fowler’s position,
adjusting with pillows under the head and knees for comfort if needed.
6. Tell the patient to rest quietly and breathe normally. Explain the importance of lying 3
still to prevent false readings.
7. Wash the patient’s skin, using gauze pads moistened with alcohol. If needed, rub it 6
vigorously with dry gauze pads to promote better contact of the electrodes.*
Copyright © 2017 by McGraw-Hill Education

8. If the patient’s leg or chest hair is dense, use a small pair of scissors to closely trim 3
the hair where you will attach the electrode. (Shaving is not allowed because of the
risk of bleeding and infection.)
9. Apply electrodes to fleshy portions of the limbs, making sure the electrodes on 6
one arm and leg are placed similarly to those on the other arm and leg. Attach
electrodes to areas that are not bony or muscular. The arm lead tabs on the
electrode point downward and the electrode tabs for the leg leads point upward.
Peel off the backings of the disposable electrodes and press them into place.*
10. Apply the precordial electrodes at specified locations on the chest. Precordial 6
electrode tabs point downward.*
11. Attach wires and cables, making sure all wire tips follow the patient’s body 6
contours.*
(continued)

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Step Points Points

Number Procedure Time Limit: 15 minutes Possible Earned
12. Check all electrodes and wires for proper placement and connection; drape wires 6
over the patient to avoid creating tension on the electrodes, which can result in
artifacts *
13. Enter the patient data into the electrocardiograph. If standardization is needed, 3
check the manufacturer’s instructions.
14. Remind the patient to lie quietly, and run the ECG.* 6
15. Check tracings for artifacts. 3
16. Correct problems and repeat any tracings that are not clear. 3
17. Disconnect the patient from the machine. 3
18. Remove the tracing from the machine, and label it with the patient’s name, the date, 3
and your initials if needed.
19. Disconnect the wires from the electrodes, and remove the electrodes from the 3
patient.
20. Clean the patient’s skin with a moist towel. 3
21. Assist the patient into a sitting position. 3
22. Allow a moment for rest, and then assist the patient from the table. 4
23. Assist the patient in dressing if necessary, or allow the patient privacy to dress. 3
24. Wash your hands. 3
25. Record the procedure in the patient’s chart. 3
26. Properly dispose of used materials and disposable electrodes. 3
27. Clean and disinfect the equipment and the room according to OSHA guidelines. 3
Total 100
0
Points
* indicates critical step.

CAAHEP Competencies Achieved

I.P.2. Perform:
I.P.2(a) electrocardiography

ABHES Competencies Achieved

2.c. Assist the physician with the regimen of diagnostic and treatment modalities as they relate to each body system
Copyright © 2017 by McGraw-Hill Education

9.a. Practice standard precautions and perform disinfection/sterilization techniques

9.e. Perform specialty procedures including but not limited to minor surgery, cardiac, respiratory, OB-GYN,
neurological, gastroenterology

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P R O C E D U R E 49-2 Holter Monitoring

Goal
To monitor the electrical activity of a patient’s heart over a 24-hour period to detect cardiac abnormalities that may go
undetected during routine electrocardiography or stress testing

OSHA Guidelines

Materials
Patient chart/progress note, Holter monitor, battery, microchip or small cassette, patient diary or log, alcohol, gauze
pads, scissors, disposable electrodes, hypoallergenic tape, drape, and electrocardiograph

Method

Step Points Points

Number Procedure Time Limit: 15 minutes Possible Earned
1. Identify the patient, introduce yourself, and explain the procedure. 4
2. Ask the patient to remove clothing from the waist up; provide a drape if necessary. 4
3. Wash your hands and assemble the equipment. 4
4. Assist the patient into a comfortable position (sitting or supine). 3
5. If the patient’s body hair is particularly dense, don examination gloves and trim the 4
areas where the electrodes will be attached.
6. Clean the electrode sites with alcohol and gauze.* 7
7. Rub each electrode site vigorously with a dry gauze square. 4
8. Attach wires to the electrodes, and peel off the paper backing on the electrodes. 7
Apply electrodes at locations as indicated by the manufacturer’s instructions. Press
firmly to ensure that each electrode is making good contact with the skin.*
9. Attach the patient cable.* 7
10. Insert a fresh battery, and position the unit.* 7
11. Tape wires, cable, and electrodes as necessary to avoid tension on the wires as the 7
patient moves.*
Copyright © 2017 by McGraw-Hill Education

12. Insert the microchip or cassette and turn on the unit.* 7

13. Ensure that the unit is on and indicate the start time in the patient’s chart.* 7
14. Instruct the patient on proper use of the monitor and how to enter information in the 7
diary. Caution the patient not to alter any diary entries; it is crucial to know what the
patient is doing at all times.*
15. Schedule the patient’s return visit for the same time on the following day. 4
16. On the following day, remove the electrodes, discard them, and clean the electrode 4
sites.
17. Wash your hands. 4
(continued)

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Step Points Points

Number Procedure Time Limit: 15 minutes Possible Earned
18. Transfer the data from the monitor to the patient’s chart according to office 5
procedure and the manufacturer’s directions.
19. Document all parts of the procedure. 4
Total 100
0
Points
* indicates critical step.

CAAHEP Competencies Achieved

I.P.2. Perform:
I.P.2(a) electrocardiography

ABHES Competencies Achieved

2.c. Assist the physician with the regimen of diagnostic and treatment modalities as they relate to each body system
9.a. Practice standard precautions and perform disinfection/sterilization techniques
9.e. Perform specialty procedures including but not limited to minor surgery, cardiac, respiratory, OB-GYN,
neurological, gastroenterology

Copyright © 2017 by McGraw-Hill Education

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Measuring Forced Vital Capacity

P R O C E D U R E 49-3 
Using Spirometry
Goal
To determine a patient’s forced vital capacity using a volume-displacing spirometer

OSHA Guidelines

Materials
Patient chart/progress note, adult scale with height bar, spirometer, patient tubing (tubing that runs from the mouthpiece
to the machine), mouthpiece, nose clip, and disinfectant

Method

Step Points Points

Number Procedure Time Limit: 10 minutes Possible Earned
1. Prepare the equipment. Ensure that the paper supply in the machine is adequate. 5
2. Calibrate the machine as necessary.* 6
3. Identify the patient and introduce yourself. 3
4. Check the patient’s chart to see whether there are special instructions to follow. 3
5. Ask whether the patient has followed instructions. 3
6. Wash your hands and don examination gloves. 5
7. Measure and record the patient’s height and weight.* 6
8. Explain the proper positioning.* 6
9. Explain the procedure. 5
10. Demonstrate the procedure.* 6
11. Turn on the spirometer, and enter applicable patient data and the number of tests to 5
be performed.
12. Ensure that the patient has loosened any tight clothing, is comfortable, and is in the 6
proper position. Apply the nose clip.*
Copyright © 2017 by McGraw-Hill Education

13. Have the patient perform the first maneuver, coaching when necessary.* 6
14. Determine whether the maneuver is acceptable. 5
15. Offer feedback to the patient and recommendations for improvement if necessary.* 6
16. Have the patient perform additional maneuvers until three acceptable maneuvers 5
are obtained.
17. Record the procedure in the patient’s chart/progress note, and place the chart and 5
the test results on the physician’s desk for interpretation.
18. Ask the patient to remain until the physician reviews the results. 5
19. Properly dispose of used materials and disposable instruments. 3

(continued)

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Step Points Points

Number Procedure Time Limit: 10 minutes Possible Earned
20. Sanitize and disinfect patient tubing, reusable mouthpiece, and nose clip. 3
21. Clean and disinfect the equipment and room according to OSHA guidelines. 3
Total 100
0
Points
* indicates critical step.

CAAHEP Competencies Achieved

I.P.2. Perform:
I.P.2(d) pulmonary function testing

ABHES Competencies Achieved

2.c. Assist the physician with the regimen of diagnostic and treatment modalities as they relate to each body system
9.a. Practice standard precautions and perform disinfection/sterilization techniques
9.e. Perform specialty procedures including but not limited to minor surgery, cardiac, respiratory, OB-GYN,
neurological, gastroenterology

Copyright © 2017 by McGraw-Hill Education

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Obtaining a Peak Expiratory

P R O C E D U R E 49-4 
Flow Rate
Goal
To determine a patient’s peak expiratory flow rate

OSHA Guidelines

Materials
Patient chart/progress note, peak flow meter, and a disposable mouthpiece

Method

Step Points Points

Number Procedure Time Limit: 10 minutes Possible Earned
1. Assemble all necessary equipment and supplies for the test. 4
2. Wash your hands and identify the patient. 4
3. Explain and demonstrate the procedure to the patient.* 10
4. Position the patient in a sitting or standing position with good posture. Make sure 10
any chewing gum or food is removed from the patient’s mouth.*
5. Set the indicator to zero.* 10
6. Ensure that the disposable mouthpiece is securely placed onto the peak flow meter. 4
7. Hold the peak flow meter with the gauge uppermost, and ensure that your fingers 4
are away from the gauge.
8. Instruct the patient to take as deep a breath as possible.* 10
9. Instruct the patient to place the mouthpiece into his mouth and close his lips tightly 4
around the mouthpiece, sealing his lips around it.
10. Instruct the patient to blow out as fast and as hard as possible.* 10
11. Observe the reading where the arrowhead is on the indicator. 4
12. Reset the indicator to zero and repeat the procedure two times, for a total of three 4
Copyright © 2017 by McGraw-Hill Education

readings. You will know the technique is correct if the reading results are close. If
coughing occurs during the procedures, repeat the step.
13. Document the readings in the patient’s chart. The highest reading will be the peak 10
flow rate.*
14. Dispose of the mouthpiece in a biohazardous waste container. 4
15. Disinfect or dispose of the peak flow meter per office policy. 4
16. Wash your hands. 4
Total 100
0
Points
* indicates critical step.

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Name Date
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CAAHEP Competencies Achieved

I.P.2. Perform:
I.P.2(d) pulmonary function testing

ABHES Competencies Achieved

2.c. Assist the physician with the regimen of diagnostic and treatment modalities as they relate to each body system
9.a. Practice standard precautions and perform disinfection/sterilization techniques
9.e. Perform specialty procedures including but not limited to minor surgery, cardiac, respiratory, OB-GYN,
neurological, gastroenterology

Copyright © 2017 by McGraw-Hill Education

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Obtaining a Pulse Oximetry

P R O C E D U R E 49-5 
Reading
Goal
To obtain a pulse oximetry reading

OSHA Guidelines

Materials
Patient chart/progress note, pulse oximeter

Method

Step Points Points

Number Procedure Time Limit: 5 minutes Possible Earned
1. Assemble all the necessary equipment and supplies. 5
2. Wash your hands and correctly identify the patient. 5
3. Select the appropriate site to apply the sensor to by assessing capillary refill in the 15
patient’s toe or finger.*
4. Prepare the selected site, removing nail polish or earrings if necessary. Wipe the 15
selected site with alcohol and allow it to air-dry.*
5. Attach the sensor to the site (if a finger is used, place in the clip).* 15
6. Instruct the patient to breathe normally. 10
7. Attach the sensor cable to the oximeter. Turn on the oximeter and listen to the tone. 5
8. Set the alarm limits for high and low oxygen saturations and high and low pulse 10
rates, as directed by the physician’s order, and turn on the oximeter.
9. Read the saturation level and document it in the patient’s chart. Report to the 10
physician readings that are less than 95%. Manually check the patient’s pulse and
compare it to the pulse oximeter. Document all the readings and the application site
in the patient’s chart/progress note.
10. Wash your hands. 5
Copyright © 2017 by McGraw-Hill Education

11. Rotate the patient’s finger sites every 4 hours if using a pulse oximeter long-term. 5
Total 100
0
Points
* indicates critical step.

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CAAHEP Competencies Achieved

I.P.1. Measure and record:
I.P.1(i) pulse oximetry
I.P.2. Perform:
I.P.2(d) pulmonary function testing

ABHES Competencies Achieved

2.c. Assist the physician with the regimen of diagnostic and treatment modalities as they relate to each body system
9.a. Practice standard precautions and perform disinfection/sterilization techniques
9.e. Perform specialty procedures including but not limited to minor surgery, cardiac, respiratory, OB-GYN,
neurological, gastroenterology

Copyright © 2017 by McGraw-Hill Education

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