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ECG / Heart rate
ECG in the operating theatre
The following measures are necessary to ensure an
effective ECG, reliable heart rate calculations and patient
safety:
– Only use ECG leads with HF protection for electro-
surgery.
– Never use ECG needle electrodes in the operating
theatre when an electro-surgical unit is being used!
– The ECG electrodes must be positioned as far away
as possible from the area of surgery and from the
neutral electrode of the electro-surgery equipment.
– The ECG electrodes must lie as close together as
possible.
– Avoid looping the ECG leads and crossing or routing
them in parallel to electro-surgery leads.
– The distance between active and neutral electro-
surgery electrodes should be kept as small as
possible.
– Deactivate pacemaker pulse detection.
– Activate the filter.
– Conductive parts of the electrodes, including the
neutral electrode, must not touch other conductive
parts, including earth.
Pacemaker pulse detection
Pacemaker pulse detection must be activated if the
patient has a pacemaker (see page 48 »ECG settings«,
»Pacemaker«)
The heart rate is normally only calculated on the basis of
the ECG complex and not on the basis of the pacemaker
pulse.
Particular care must be taken in the case of pace-
maker patients, since the pacemaker pulses may be
mistaken for ventricular complexes. In such a case,
calculation of the heart rate would be continued even
in the absence of an ECG!
The following points must also be noted:
– The R-waves of the ECG must be greater than
0.5 mV in order to ensure reliable functioning. If this
is not the case, the ECG lead must be changed or
the ECG electrodes repositioned.
– Pacemaker pulse detection should be deactivated if
it is not required.
– Pacemaker pulse detection should be deactivated in
the operating theatre when using electro-surgery
equipment.
170
Applying electrodes
– Carefully prepare the areas of skin to which the
electrodes are to be applied.
– The electrodes should be positioned in areas in which
patient movement will not have a negative effect on
the ECG (i.e. not on top of muscles).
– Appropriate points of contact for the electrodes when
using 3, 4 or 5 electrodes can be seen from the
diagrams alongside.
Abbreviations used in the diagrams:
Rd = Red electrode
Ye = Yellow electrode
Gn = Green electrode
Bl = Black (neutral) electrode
Figures 1 and 2
Points of contact when using three ECG electrodes.
The points of contact shown in Figure 1 are also suitable
for monitoring thoracic breathing, and the positi-ons in
Figure 2 are suitable for monitoring both thoracic and
abdominal breathing.
Bl
Figure
1
Rd
Figure
2
Figure 3
Points of contact when using four or five ECG
electrodes. (e.g. for ST-segment analysis).
Rd
Bl
Figure
3
Rd
Ye
Bl
Ye
Ye
Gn
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