Exeter Clinical and Health Research

Transcription

1 Exeter Clinical and Health Research Standard Operating Procedure: Recording a 12 Lead Electrocardiogram (ECG) SOP Number: NIHRexe017GEN Version Number & Date: V1 18/08/2015 Review Date: 18/08/2016 Superseded Version Number & Date: PCRF/17/gen V Author: Name: Suzette Mitchell Position: Research Nurse Signature: Date: 25/06/2015 Approved by: Name: Anna Steele Position: Senior Research Nurse Signature: Date: 12/08/2015 Senior Management Agreement: Name: Gillian Baker Role: CRF Manager Signature: Date: 18/08/2015 I agree that appropriate members of my workforce (as named above) have written and approved this SOP for use in clinical research. Page 1 of 5

2 1. BACKGROUND: A 12 lead ECG is a non-invasive procedure that is used to ascertain information about the electrophysiology of the heart. When taking an ECG recording, electrodes are placed in strategic points on the person s body. This gives 12 different views of the heart. a. For details on how the machine operates, reference should be made to the operator manual. b. The machine should be kept clean, tidy and adequately stocked. c. The machine should be kept in good working order and all faults reported to the Medical Electronics Department (MEM) using the yellow cards, found in the Nurses office: room number SCOPE: This SOP applies generically to clinical trials and research projects, clinical and health research in Exeter, unless a trial agreement specifically indicates that another organisation s SOP should be used. 3. PURPOSE: To ensure correct and uniform recording of 12 lead Electrocardiogram (ECG) in the Exeter Clinical Research Facility (ECRF). 4. DEFINITIONS AND ABBREVIATIONS The headings below contain the definition of terms and meanings of abbreviations used within this document. ECG Electrocardiogram MEM SOP Medical Electronics Management Standard Operating Procedure 4. ROLES AND RESPONSIBILITIES: It is the responsibility of staff undertaking clinical research to read and use this SOP when undertaking the recording of a 12 Lead ECG, to understand the indications for recording an ECG, and become familiar with how to input all patient data into the machine, and are familiar with correct electrode Page 2 of 5

3 placement as described in this SOP, and demonstrated in the diagram: section SKILL LEVEL: This procedure should only be carried out by personnel who have undergone the appropriate departmental training. Personnel to include; Doctors, Registered Nurses, Student Nurses and Research Practitioners who have undergone the appropriate training and are deemed to be competent. 6. EQUIPMENT: Equipment required: ECG machine ECG paper Electrodes Alcohol swabs Disposable razors 7. PROCEDURE: 1. Explain the procedure to the patient / volunteer, gather equipment and wash hands 2. Ensure PASS test is successful (this is the self test performed by the machine itself after its initial switch on) 3. Ensure that the speed is set at 25mm/second, unless otherwise directed 4. Ensure that the patient / volunteer is comfortably positioned either lying or sitting, so that muscles will be relaxed 5. Expose their forearms, lower legs and chest 6. Prepare skin by rubbing the electrode site with an alcohol swab if necessary, and allow area to dry. Light shaving may also be required to ensure optimum adhesion of the electrodes. Shaving may be avoided by rubbing chest hair with an alcohol swab to remove excess oil; this will improve electrode contact. 7. Apply electrodes as follows and attach the appropriate lead to each electrode Chest Leads V1 4th intercostal space to the right of the sternum Limb Leads Right wrist R Page 3 of 5

4 V2 4th intercostal space to the left of the sternum Left wrist L V3 Directly between leads V2 and V4 Right ankle N V4 5th intercostal space at mid-clavicular line Left ankle F V5 Level with V4 at left anterior axillary line V6 Level with V5 at left mid-axillary line. 8. Input all the participants details i.e. Name, DOB and hospital or NHS number. This is a trust requirement so all machines are all pre-set to accept this information. Failure to input this information will mean that the ECG machine will not record. 9. Ask the patient / volunteer to relax and remain motionless for 10 seconds; it is not necessary for them to hold their breath. 10. Commence recording Page 4 of 5 Locating the electrode positions Locating the V1 position (4th intercostal space) is important because it is the reference point for locating the placement of the remaining V leads. To locate the V1 position: Place your finger at the notch at the top of the sternum Move your finger slowly downward about 1.5 inches until you feel a horizontal ridge or elevation. This is the angle of Louis where the manubrium joins the body of the sternum Locate the 2 nd intercostal space on the right side, lateral to and just below the

5 angle of Louis Move your finger down two more intercostal spaces to the 4 th intercostal space, which the V1 position Other points to remember Whenever possible, attempt to obtain the ECG with the patient / volunteer in a supine position. If they cannot tolerate this, place them in a semi-reclining or sitting position If lead placement is altered for any reason, state this on the ECG printout On females with pendulous breasts, always place leads V3-V6 under the breast rather than on the breast Never use the nipples as reference points for electrode location as nipple locations may vary widely Many people use body lotion which will interfere with electrode contact and ability to record an ECG. The skin may need further cleaning to remove the lotion. In the case of paediatrics up to the age of 7 years, V4R is used at the expense of V3. V4R refers to the 5 th right intercostal space in the mid-clavicular line 11. DESIRED OUTCOME: An accurate, clear and diagnostic ECG is recorded. 12. REFERENCES: Dougherty, L. and Lister, S The Royal Marsden Hospital Manual of Clinical Nursing Procedures; Royal Marsden Foundation Trust. 9th Edition. Wiley- Blackwell Publishers, London. (Royal Marsden can be found on IaN) Page 5 of 5