Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
ACCESS. E.J.C. Montilla, Tacurong City
College of Health Sciences
ELECTROCARDIOGRAM (ECG)
Name: __________________________________________Year Level/ Group:____________
Year and Sec.: ___________________________________ Inclusive Dates: ______________
Direction: In using the checklist, the values of the numbers, which may be used are the
following:
5 – Excellent
✓ Demonstrated outstanding mastery, competency, and proficiency with the task and procedure
and its corresponding rationale. Students utilizes the Nursing process in the care of client
correctly and with a mild degree of supervision.
4 – Very Good
✓ Demonstrated above average knowledge and skills in the performance of the procedure. Student
utilizes the Nursing Process in the care of client correctly and a moderate degree of supervision.
3 – Fair
✓ Demonstrated barely acceptable standard in mastery and proficiency of the procedure
performed. Student utilizes the Nursing Process in the care of client correctly and a high degree
of supervision.
2 – Poor
✓ Demonstrated below standard in mastery and proficiency of the procedure performed. Student
utilizes the Nursing Process in the care of client correctly and a high degree of supervision.
1 - Very Poor
✓ Very unsatisfactory presentation and performance of the task and procedure. Student fails to
utilizes the Nursing Process in the care of client correctly even with close supervision.
ELECTROCARDIOGRAM (ECG)
• An electrocardiogram (ECG) is a test which measures the electrical activity of the heart
to show whether or not it is working normally.
• records the heart's rhythm and activity on a moving strip of paper or a line on a screen.
Purpose/s:
• To look for the cause of chest pain
• To evaluate problems which may be heart-related
• To identify irregular heartbeats
• To help determine the overall health of the heart before procedures such as surgery; or
after treatment for conditions such as a cardiac arrest or heart attack (myocardial
infarction, or MI), endocarditis (inflammation or infection of one or more of the heart
valves); or after heart surgery or cardiac catheterization
• To see how an implanted pacemaker is working
• To get a baseline tracing of the heart's function during a physical exam; this may be
used as a comparison with future ECGs, and determine if there have been any changes
Equipment:
• ECG machine
• Recording paper
• Disposable/ECG electrodes
• Adhesive remover swabs
• 4 × 4 gauze pads
• Soap and water, if necessary
• PPE, as indicated
• Bath blanket
PROCEDURE RATING
1. Place the electrocardiogram (ECG) machine close to the
5 4 3 2 1
patient's bed and plug the power cord into the wall outlet.
2. Perform hand hygiene. 5 4 3 2 1
3. Check the patient's identification 5 4 3 2 1
4. Secure the privacy of the client. 5 4 3 2 1
5. Ask the client if he/she has dentures. jewelries, keys or coins
5 4 3 2 1
with him/her. Have the client remove metals away from the body.
6. Ask the client if he/she has implants, note it on the result. 5 4 3 2 1
7. Ask the client to change to a hospital gown for the top. Proceed
5 4 3 2 1
to open the gown to expose the chest.
8. Promote the adherence of the electrodes to the chest skin
surface of the client by:
5 4 3 2 1
- Cutting excess chest hair.
- Wipe with alcohol to remove excess oil and dirt.
9. As you set up the machine to record a 12-lead ECG, explain the
procedure to the patient. Tell him that the test records the heart's
electrical activity, and it may be repeated at certain intervals. 5 4 3 2 1
Emphasize that no electrical current will enter his body. Also, tell
the patient that the test typically takes about 5 minutes.
10. Have the patient lie supine in the center of the bed with his arms
at his sides. Raise the head of the bed it necessary to promote
comfort. Expose the patient's arms and legs and drape
appropriately. Encourage the patient to relax the arms and legs.
5 4 3 2 1
If the bed is too narrow, place the patient's under his buttocks to
prevent muscle tension. Use this technique it the patient Is
shivering or trembling. Make sure the feet are not touching the
bed board.
11. Select flat fleshy areas to place the electrodes. Avoid muscular
and bony areas which may cause result interference. If the
patient has an amputated limb, choose a site on the stump. In
the female, position the electrodes below the breast tissue. If the 5 4 3 2 1
breasts are large, you may have to position the breast laterally. If
an area is with excessive hair, clip it. Clean excess oil or other
substances from the skin
12. Apply electrode paste or gel or the disposable electrodes to the
patient's wrists and to the medial aspects of his ankles. If using
paste or gel, rub it into the skin. If using disposable electrodes,
peel off the contact paper and apply electrodes directly to the 5 4 3 2 1
prepared site, as recommended by the manufacturer's
instructions. Make sure the metal parts of the electrodes are
clean and bright.
13. If using paste or gel, secure electrodes promptly after you apply
the conductive medium. Never use alcohol or acetone pads in 5 4 3 2 1
place of the electrode paste or gel.
14. Connect the limb lead wires to the electrodes. The tip of each
lead wire is lettered, and color coded for easy identification:
- White or RA lead wire goes to the right arm;
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- Green or RL lead wire to the right leg;
- Red or LL lead wire to the left leg
- Black or LA lead wire to the left arm
15. Expose the patient's chest. Put a small amount of electrode gel
or paste on a disposable electrode at each electrode position.
Position chest electrodes as follows;
- V1: 4th intercostal space at right sternal border (Red)
- V2: 4th intercostal space at left sternal border (Yellow)
- V3: halfway between V2 and V4 (Green) 5 4 3 2 1
- V4: 5th intercostal space at midclavicular line (Brown)
- V5: 5th intercostal space at anterior axillary line (halfway
between V4 and V6) (Black)
- V6: 5th intercostal space at midaxillary line, level with V4
(Violet)
16. After applying the electrodes, enter information into the ECG. 5 4 3 2 1
Applying electrodes first allows the electrode gel to contact and
penetrate the skin surface.
17. Ask the patient to relax and breath normally. Tell him to lie still
5 4 3 2 1
and not to talk when you record his ECG.
18. Press the "AUTO" or "RECORD" button. 5 4 3 2 1
19. Check the tracing quality. If inconsistency is present, try to
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correct the problem. It may be necessary to use fresh electrodes.
20. The machine will record all 12 leads automatically, recording
three consecutive leads simultaneously.
a. Bipolar limb lead - L1, L2, L3
b. Unipolar limb lead - AVR, AVL, AVF 5 4 3 2 1
c. Chest Lead - V1, V2, V3, V4, V5, V6
Some machines have a display screen so you can preview
waveforms before the machine records them on paper.
21. When the machine finishes recording the 12-lead ECG, remove
5 4 3 2 1
the electrodes and clean the patient's skin.
22. After disconnecting the lead wires from the electrodes, dispose
5 4 3 2 1
or clean the electrodes, as indicated.
23. Label the ECG recording with the patient's name, age, date, and
time taken. Also, record any appropriate clinical information on 5 4 3 2 1
the ECG and other necessary data per hospital policy.
24. Perform after care and return the ECG machine properly. 5 4 3 2 1
25. Mount to the recording/result strip to the ECG sheet. 5 4 3 2 1
26. Refer the ECG sheet to the physician. 5 4 3 2 1
27. Document the procedure done to include the date and time as
well as significant responses by the patient in the chart.
Sub-Total=
Total Score: _________
Average: _________
RD Grade: _________
Other comments/suggestions:
_________
_________
_________
Clinical Instructor: ____________________________________________
(Name & Signature/Date)
