Performing a 12-lead ECG
Learning aim:
Understand how to perform a standard 12-lead ECG on a patient
Utilise a systematic approach in summarising and presenting ECG findings, with a particular focus on
recognising a normal ECG, and when ECG abnormalities are present
Learning objectives: [1]
1. Perform a competent 12-lead ECG investigation on a patient.
2. Summarise and present ECG findings utilising a systematic approach
Materials checklist:
ECG machine and associated limb/chest leads X1
ECG electrodes X1
Examination couch X1
Privacy Screens X1
Examination checklist:
Not Partly Done
done done well
Introduction:
W:
I: Introduce self to patient (name and role)
I: Confirm patient identity (name and DOB)
P: Gain patient consent
E: Explain and discuss procedure with patient- if appropriate, discuss
shaving of chest hair to facilitate performing an ECG
R: Reposition patient appropriately:
procedure (offer blanket to allow exposure only when necessary).
- Expose lower legs and wrists for application of limb electrodes.
-Ask the patient to lie on the cough at a 45-degree angle
Preparation:
1. Check for allergies
2. Offer chaperone and ensure privacy
3.
4. Don gloves and appropriate PPE
Electrode Placement
-Check expiry dates of electrodes
-Consider shaving/cleaning areas where you need to place electrodes. -
Explain this clearly and gain consent before proceeding.
(For the purposes of CSFC practice, do not undertake any shaving of
hair)
Chest Electrodes
-Apply the 6 chest electrodes in the following locations-
V1- 4th IC space at R sternal edge
V2- 4th IC space at L sternal edge
V3- midway between the V2 and V4 electrodes
V4- 5th IC space in the midclavicular line
V5- L anterior axillary line at the same horizontal level as V4
V6- L mid-axillary line at the same horizontal level as V4 and V5
-Once all electrodes have been applied, attach the associated chest leads
Limb Electrodes
-Apply the four limb electrodes on a distal bony prominence in the
following locations-
Red (RA)- ulnar styloid process of R arm
Yellow (LA)- ulnar styloid process of L arm
Green (LL)- medial or lateral malleolus of L leg
Black (RL)- medial or lateral malleolus of R leg
Mnemonic-
-Once all electrodes have been applied, attach the associated limb leads
Recording the ECG trace
-Turn on the ECG machine and ensure paper has been loaded
-Double check all electrodes attach in appropriate locations
-Politely ask patient to remain still and not talk during recording
-Press the record button the ECG machine to generate trace
-If the trace is poor, double check connection and re-record
Completing the procedure
-Once an adequate trace has been obtained, switch off ECG machine
-Explain to the patient that the procedure is now complete, and ask the
patient to get dressed again
-Thank the patient
- indication
for ECG
-Dispose of any PPE appropriately and wash hands
-Document findings in patient notes
Scoring:
Score
Domain: 1 (Poor) 2 (Below 3 4 (Good) 5 (Excellent)
Average) (Borderline/Average)
Communication Skills
Practical Skills
Clinical Knowledge
and Problem Solving
Professionalism Very Very professional
unprofessional
References:
[1]: ECG CSFC pre-narrated presentation
[2]: Geeky Medics “How to Record an ECG- OSCE Guide”
[Link]
