COLLEGE OF NURSING AND MIDWIFERY
NCM 110 EMERGENCY NURSING
ELECTROCARDIOGRAM
NAME: _______________________________________________________ SCORE: _____________
INSTRUCTOR: _________________________________________________Time Started:__________
● YEAR/BLK __________________________________ Date: ________________
Learning Outcome:
At the end of this activity, the learner will be able to correctly perform a standard 12-lead ECG placement on a patient, adhering
to anatomical landmarks, infection control protocols, and patient communication standards, with at least 90% accuracy as
assessed through a skills checklist.
DIRECTION: Rate the learner based on the competencies listed below.
Rating Description
2 - Moderately Acceptable Demonstrates expected procedure/ behavior with minimal error.
1 - Slightly Acceptable Demonstrates expected procedure/ behavior with many errors.
0 - Unacceptable Missed procedure or procedure is done but entirely incorrect.
Action 0 1 2 Remarks
EQUIPMENT:
● ECG Machine
● ECG Electrodes
● Conduction paste or gel
● Recording paper
● Clippers (Optional)
PREPARATION
1. Place the electrocardiogram (ECG) machine
close to the patient’s bed and plug the power cord into the
wall outlet.
2. Perform hand hygiene. Check the patient’s
identification
3. As you set up the machine to record a 12-lead
ECG, explain the procedure to the patient. Tell him that
the test records the heart’s electrical activity and it may be
repeated at certain intervals. Emphasize that no electrical
current will enter his body. Also, tell the patient that the
test typically takes about 5 minutes.
4. Have the patient lie supine in the center of the
bed with his arms at his sides. Raise the head of the bed if
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necessary to promote comfort. Expose the patient’s arms
and legs and drape appropriately. Encourage the patient
to relax the arms and legs. If the bed is too narrow, place
the patient’s under his buttocks to prevent muscle tension.
Use this technique if the patient is shivering or trembling.
Make sure the feet are not touching the bed board.
5. Select flat fleshy areas to place the electrodes.
Avoid muscular and bony areas. If the patient has an
amputated limb, choose a site on the stump.
6. If an area is excessively hairy, clip it. Clean
excess oil or other substances from the skin
7. Apply electrode paste or gel or the disposable
electrodes to the patient’s wrists and to the medial
aspects of his ankles. If using paste or gel, rub it into the
skin. If using disposable electrodes, peel off the contact
paper and apply electrodes directly to the prepared site,
as recommended by the manufacturer’s instructions.
Position disposable electrodes on the legs with the lead
connection pointing superiorly.
8. If using paste or gel, secure electrodes promptly
after you apply the conductive medium. Never use alcohol
or acetone pads in place of the electrode paste or gel.
9. Connect the limb lead wires to the electrodes.
The tip of each lead wire is lettered and color coded for
easy identification.
● White or RA lead wire goes to the right arm;
● Green or RL lead wire to the right leg;
● Red or LL lead wire to the left leg
● Black or LA lead wire to the left arm
● Brown or Vi to V6 lead wires to the chest
● Make sure the metal parts of the electrodes are
clean and bright.
10. Expose the patient’s chest. Put a small amount of
electrode gel or paste on a disposable electrode at each
electrode position. Position chest electrodes as follows;
● V1: 4th ICS at right sternal border
● V2: 4th ICS at left sternal border
● V3: halfway between V2 and V4
● V4: 5th ICS at midclavicular line
● V5: 5th ICS at anterior axillary line (halfway
between V4 and V6)
● V6: 5th ICS at midaxillary line, level with V4
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11. Check to see that the paper speed selector is set
to the standard 25mm and that the machine is set to full
voltage.
12. If necessary, enter the appropriate patient
identification data.
13. Ask the patient to relax and breath normally. Tell
him to lie still and not to talk when you record his ECG.
14. Press the AUTO button. Observe the tracing
quality. The machine will record all 12leads automatically,
recording three consecutive leads simultaneously. Some
machines have a display screen so you can preview
waveforms before the machine records them on paper.
Adjust waveform if necessary. If any part of the waveform
extends beyond the paper when you record the ECG,
adjust the normal standardization to half- standardization
and repeat. Note this adjustment on the ECG strip
because this will need to be considered in interpreting the
results.
15. When the machine finishes recording the 12-lead
ECG, remove the electrodes and clean the patient’s skin.
16. After disconnecting the lead wires from the
electrodes, dispose of or clean the electrodes, as
indicated.
17. Label the ECG recording with the patient’s name,
room number, and facility identification number, if not
done by the machine. Also record the date and time as
well as any appropriate clinical information on the ECG.
18. Document the test’s date and time as well as
significant responses by the patient in the medical record.
COMPUTATION: Total score/ total number of items x 100= __________
Prepared by: Noted:
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ALLYN B. ESPINOSA, RN EMILY JOY M. CORPUZ, MAN, RN
Faculty, College of Nursing and Midwifery BSN Program & RLE Coordinator
Date Signed: Date Signed:
Approved by:
DR. MARINA MAGNOLIA G. NINOBLA
Dean, College of Nursing and Midwifery
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