Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [144], C).
2. 2.Show
   Wash and dry hands and/or use an alcohol‐based handrub.
   To prevent cross‐infection (NHS England and NHSI [124], C).
3. 3.Show
   Ensure that the patient is comfortably positioned in a semi‐recumbent position with their chest exposed. Any variations to the standard recording techniques must be highlighted on the ECG recording (e.g. ‘ECG recorded while patient in wheelchair’).
   To ensure optimal recording and comfort of the patient (SCST [183], E).

   The ECG may vary depending on the patient's position so it is important to note this on the ECG (Wesley [209], C).
4. 4.Show
   If necessary, prepare skin by cleaning with soap and water and/or shaving using a single‐use razor.
   To ensure a good grip and therefore good contact between the skin and electrodes, which results in fewer electrical artefacts (SCST [183]). Shaving should be avoided due to the risk of infection if the skin is grazed or bleeding if the patient is on anticoagulation therapy. E

Procedure

1. 5.Show
   Apply the limb and chest electrodes as described in Table 14.3 or as shown in Figure 14.15. For advice on placement in females and patients with known cardiac abnormalities see the section on specific patient preparation above.
   To obtain a three‐dimensional view of the electrical activity of the heart (Wesley [209], E). Following a standard arrangement ensures consistency between recordings and prevents invalid recordings and misdiagnosis (SCST [183], C).
2. 6.Show
   Attach the cables from the ECG machine to the electrodes, checking that the cables are connected correctly and to the relevant electrodes.
   To obtain the ECG recording and to ensure the correct polarity (Blows [21], E).
3. 7.Show
   Ensure that the cables are not pulling on the electrodes or lying over each other. Offer the patient a gown or sheet to place over their exposed chest.
   To reduce the number of electrical artefacts and to obtain a clear ECG recording (Aehlert [3], E). To ensure patient dignity and reduce shivering (SCST [183], C).
4. 8.Show
   Ask the patient to relax and refrain from movement.
   To obtain the optimal recording via the reduction of artefacts from muscular movement (SCST [183], C).
5. 9.Show
   Encourage the patient to breathe normally and not to speak while the recording is being taken.
   Speaking can alter the recording (Blows [21], E).
6. 10.Show
   Switch the machine on and enter the patient's details.
   To ensure that it is clear which patient the ECG was taken from (NMC [144], C).
7. 11.Show
   Check that the machine is functioning correctly and that calibration is 10 mm/mV.
   To ensure standard recording and to aid interpretation (SCST [183], C).
8. 12.Show
   Commence the recording by pressing ‘Start’, ‘Go’ or ‘Capture’ (according to the specific machine).
   To obtain the ECG. E
9. 13.Show
   In the case of artefacts or poor recording, check the electrodes and connections.
   To ensure optimal recording (Wesley [209], E).
10. 14.Show
    During the procedure, give reassurance to the patient.
    To ensure the patient is informed and reassured (SCST [183], E).
11. 15.Show
    Detach the ECG print‐out and ensure the recording contains the patient's name and hospital number, and the date and time of the procedure. Also include any diagnostic information (i.e. if the patient had chest pain during the recording) and deviations from the standard electrode placement.
    To ensure that the ECG forms part of the correct patient's medical record (NMC [144], C).

    To help with diagnosis and interpretation (SCST [183], C).

Post‐procedure

1. 16.Show
   Inform the patient that the procedure is completed, remove the electrodes and help the patient to re‐dress if required.
   To ensure that the patient can relax and that the electrodes are removed to prevent them drying out and causing skin irritation. E
2. 17.Show
   Wash and dry hands and/or use an alcohol‐based handrub.
   To prevent cross‐infection (NHS England and NHSI [124], C).
3. 18.Show
   Inform the relevant nursing and medical staff that the ECG has been completed. Show the recording to the person who will analyse it.
   To enable relevant nursing and medical staff to use the ECG data in their care planning and treatment (NMC [144], SCST [183], C).
4. 19.Show
   File the ECG recording in the appropriate documentation.
   To ensure appropriate record keeping and aid continuity of care (NMC [144], C).
5. 20.Show
   Clean the ECG machine in accordance with the manufacturer's recommendations. Return it to its storage place and plug it in to mains electricity to keep the battery fully charged.
   The ECG machine forms part of a department's emergency equipment and should always be available and in good working order with a charged battery for use in an emergency (SCST [183], E).