Electrocardiograph
or for Holter hereRoles and Responsibilities
- Clinical Leads, Matrons and Service Manager are responsible for ensuring that all clinical staff have knowledge and understanding of the local processes of arranging and performing ECGs.
- The Matron and Service Manager are responsible for ensuring that the teams have access to an ECG machine that is in good working order. EBME is responsible for calibrating medical devices.
- All clinicians who use a 12 lead ECG machine will have local training in how to operate the ECG machine. A user guide is kept within the bag, and an electronic copy stored on shared drive.
- A copy of ECG will be sent by the Practitioner undertaking the ECG via Pando or NHS Email to the Virtual Ward Consultant, or designated Medical Officer, on call for it to be interpreted.
- Medical Staff are responsible for interpreting ECGs and will:
- Document results on EMIS/CERNER, and any actions required
- Ensure ECG is appropriately dated and copied into EMIS
- Seek cardiology opinion if required and record that opinion
For whom?
- Confirmation of rate and rhythm or identifying new rhythm changes
- To corroborate a HR compared with oximetry or other methods
- To check rate controls in patients with AF
Not for use in acute chest pain or Acute coronary syndrome (ACS) – if there is clinical suspicion of ACS patient should be transferred immediately to ED to be assessed in a safer environment
Information/equipment required to carry out procedure
- ECG machine
- ECG paper
- ECG electrodes
- Abrasive pad for skin preparation
- Razor (if needed)
- skin wipes
- Private room
Procedure
ECG Machine Preparation
| 1. | Ensure all equipment is prepared and ready |
|---|---|
| 2. | Ensure ECG leads are ready: 6 chest leads, 4 limb leads |
| 3. | Ensure the ECG machine is loaded with appropriate ECG paper before performing procedure |
| Calling patient | |
| 4. | Introduce self and explain procedure |
| 5. | Ensure you obtain consent from the patient. |
| 6. | Check patient identity and ensure demographic information is correct. |
Patient preparation
| 7. | Ask patient to remove clothing to waist and lay on couch. Talk the patient through the whole procedure Ensure temporary covering (blanket etc.) is available until procedure is ready to be carried out. Patient dignity must be maintained throughout procedure. |
|---|---|
| 8. | Shave any chest hair where electrodes are to be placed. (ECG electrodes must be in full direct contact with skin to work properly). |
| 9. | Clean electrode sites |
| 10. | Offer support and reassurance to patients as appropriate. |
| 11. | Expose and clean areas where ECG electrodes are to be attached: - chest, arms (wrists), and legs (ankles). |
ECG process
| 12. | Apply electrodes to skin, ensuring correct placement, (see below) and attach correct leads to electrodes. |
|---|---|
| 13. | Turn on ECG machine and enter patient details |
| 14. | Ask the patient to relax completely. Any skeletal muscle activity will be picked up as interference. If the trace obtained is no good, check that all the dots are stuck down properly – they have a tendency to fall off. |
| 15. | Record and print Different ECG machines have different buttons for recording tracing. Ensure you know which button to press prior to procedure. |
| 16. | Ensure reading has printed out correctly |
When procedure complete
| 17. | Explain procedure is complete and disconnect leads |
|---|---|
| 18. | Remove electrodes |
| 19. | Ask patient to get dressed |
| 20. | Ensure the ECG machine is loaded with appropriate ECG paper after performing procedure |
Limb Leads
| RA - red | Right forearm, proximal to wrist |
|---|---|
| LA - yellow | Left forearm, proximal to wrist |
| LL - green | Left lower leg, proximal to ankle |
| RL - black | Right lower leg, proximal to ankle |
Chest Leads
| V1 | 4th intercostal space (ICS), RIGHT margin of the sternum |
|---|---|
| V2 | 4th ICS along the LEFT margin of the sternum |
| V4 | 5th ICS, mid-clavicular line |
| V3 | midway between V2 and V4 |
| V5 | 5th ICS, anterior axillary line (same level as V4) |
| V6 | 5th ICS, mid-axillary line (same level as V4) |
Urgent continuous ECG monitoring in Virtual Ward is provided using the CardioScan platform with direct on-boarding of patients by the Virtual Ward team.
Requesting continuous ECG monitoring requires you to on-board/enrol a patient directly to the platform. To on-board ('enrol') a patient, login to BeatBox cloud site (username and password is required.)
guide to enrolling
In order to keep track of orders, please also email Patient Name & NHS no. to Amanda Rose
Self applied device
- as able to comprehend the instructions
- as physically able to apply the device
Device applied by Virtual Ward Team
MyPatch
| Step 1 skin prep: remove hair and clean skin |  |
| Step 2 remove device from pouch keep the pouch |  |
| Step 3 press recorder onto 4 pins |  |
| Step 4 trial fit make sure recorder is vertical top of patch 3 fingers below top of sternum bottom above nipple |  |
| Step 5 press power button once for green button to light |  |
| Step 6 peel plastic off patch |  |
| Step 7 apply patch ensuring smooth adherence |  |
Vine
| Preparation • attach 3 spots to device 1st • clean skin with prep |  |
| Fitting • peel backing off • place on chest as per diagram • ensure spots are pressed firmly and smoothly • recording begins automatically once spots attached |   |
| Patient advice | • simple, quick, firm double tap on device will create an alert on recording • patient to double tap if feels palpitations, pain or any other significant discomfort - green, red and yellow lights will flash when double tapped • advise patient that device is showerproof for short showers do not submerse. Dab dry afterwards. • extra spots are provided should any loosen • patient to keep diary of events to associate with double taps |
From: ECG SOP: Sr Anna Ryan