Record An Ecg; Patient Preparation; Patient Hookup - Welch Allyn RScribe User Manual

RECORD AN ECG

Patient Preparation

Before attaching the electrodes, assure the patient fully understands the procedure and what to expect.

Privacy is very important in assuring the patient is relaxed.

Reassure the patient that the procedure is painless and that the electrodes on their skin are all that they
will feel.

Make sure the patient is lying down and is comfortable. If the table is narrow, tuck the patient's hands
under his/her buttocks to ensure their muscles are relaxed.

Once all the electrodes are attached, ask the patient to lie still and to not talk. Explain this will assist you in
acquiring a good ECG.
Preparing Patient Skin
Thorough skin preparation is very important. There is natural resistance on the skin surface from various sources
such as hair, oil, and dry, dead skin. Skin preparation is intended to reduce resistance and maximize the quality of
the ECG signal.
To prepare the skin:

Clip hair from electrode sites if necessary.

Wash area with warm, soapy water or alcohol if dirty or oily.

Dry skin vigorously with a pad such as 2 x 2 or 4 x 4 gauze to remove residue from cleaning, dead skin
cells and oil, and to increase capillary blood flow.
NOTE: With elderly or frail patients take care to not abrade the skin causing discomfort or bruising.

Patient Hookup

Correct electrode placement is essential for acquiring a diagnostically valid ECG.
A low resistance highly conductive pathway from the skin surface to the electrocardiograph provides superior noise-
free waveforms. Good quality silver-silver chloride (Ag/AgCl) electrodes within their expiration date should be
used whenever taking an ECG.
TIP: Electrodes should be stored in an air-tight container. Electrodes will dry out if not stored properly
causing reduced adhesion and conductivity, leading to poor trace quality.
To Attach the Electrodes
1. Expose the arms and legs of the patient to attach the limb leads.
2. Place the electrodes on flat, fleshy parts of the arms and legs.
3. If a limb site is not available, place the electrodes on a perfused area of the stump.
4. Attach the electrodes to the skin. A good test for firm electrode contact is to slightly tug on the electrode to
check adhesion. If the electrode moves freely, it needs to be changed. If the electrode does not move
easily, a good connection has been obtained.
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