ekg cardiovascular
12-Lead Electrocardiogram (ECG/EKG)
A 12-lead ECG (EKG) records the heart's electrical activity from several directions at once using electrodes on the limbs and chest.
16 steps5 criticalLimit 10 minAlways tested
Steps
- 1Verify the provider's order and perform hand hygiene
- 2Critical stepCheck the ECG machine: powered or charged, enough paper, lead wires untangled and plugged in, and electrodes not expired
- 3Identify the patient using two identifiers, explain the procedure in simple terms (the patient will feel nothing), and provide privacy
- 4Enter the patient's demographic data as the machine requires
- 5Help the patient lie comfortably, warm and rested, with arms, legs and the front of the chest exposed
- 6Critical stepPrepare the skin at the electrode sites: remove oil, moisture and excess hair, and dry sweaty or moist skin
- 7Critical stepAttach one electrode to each limb as marked (right and left, arm and leg); site on the limb follows your course or facility
- 8Attach the chest electrodes: V1 fourth intercostal space right sternal border, V2 fourth intercostal space left sternal border, V3 midway between V2 and V4, V4 fifth intercostal space midclavicular line, V5 and V6 level with V4 at the anterior axillary and midaxillary lines
- 9Connect each lead wire to its matching, labeled electrode
- 10Ask the patient to hold still and make sure the patient is not shivering or moving before recording
- 11Critical stepCheck that the machine is set to 25 mm/sec and 1 mV = 1 cm, then record all leads
- 12Critical stepInspect the tracing for quality and artifact, and repeat it if there are problems
- 13If the client has an abnormal cardiac pattern, assess level of consciousness, carotid pulse, and any complaint of chest pain or shortness of breath, and request emergency help if indicated
- 14Disconnect the leads, remove the electrodes, clean the skin, check for redness or irritation, and help the patient redress
- 15Label the tracing with the patient's name, date of birth, date and time, and any symptoms during the recording
- 16Perform hand hygiene, notify the provider of any abnormalities, and give the tracing to the provider and place it in the chart per facility policy
What graders are watching for
Tips
- Chest electrode placement matters: ECGs are compared over time, and a changed lead position can lead to a misread tracing; one common error is placing V1 and V2 too high (second or third intercostal space)
- Poor skin contact, a moving or shivering patient, and interference cause baseline wander and noisy tracings, so prepare the skin and wait until the patient is still
- The machine may print an interpretation, but the provider evaluates the findings; your job is a clean, correctly labeled tracing
Common mistakes
- Placing V1 and V2 too high (second or third intercostal space), which can change the tracing.
- Skipping skin preparation, so contact is poor and the baseline wanders.
- Recording while the patient is shivering or moving, which adds artifact.
- Wrong paper speed or calibration setting.
Practice this skill
Practise the sequence with critical-step highlighting and a rationale for each step.
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Sources and how we check them: How we verify.