INTERDISCIPLINARY CLINICAL MANUAL Policy and Procedure

Transcription

1 INTERDISCIPLINARY CLINICAL MANUAL Policy and Procedure TITLE: 12 Lead Electrocardiogram (ECG) NUMBER: (Including Right Precordial and Left Posterior Leads) Effective Date: October 2014 Page 1 of 6 Applies To: Holders of Interdisciplinary Clinical Manual Lead application and recording of a 12 lead ECG is a Post-Entry Level Competency for: LPN s Medical Lab Technologist (MLT) and Medical Lab Assistant (MLA) at Eastern Shore Memorial Hospital and requires assessment of competency before performing. Lead application, recording of 12 lead ECGs and extra leads and assessment of 12 lead ECGs are Post-Entry Level Competencies for RN s which require assessment of competency before performing. (Includes assessment as compared to normal or previous 12 lead ECGs) POLICY 1. Prior to initially performing this skill, the appropriate Health Care Professional (RN, LPN, MLT, MLA) is to successfully complete all pertinent/applicable components of the selfdirected learning module, including the demonstration of the skill to the clinical nurse educator, preceptor or delegate In addition, RNs who derive 12 Lead ECGs from continuous cardiac monitoring systems, and RN s who assess 12 lead ECGs in comparison to normal or previous 12 lead ECG require proficiency in the PELC CC Cardiac Monitoring Cardiac Rhythm Assessment and Telemetry Monitoring. 2. The Health Care Professional is to conduct a yearly self-assessment of competency level and develop a plan in conjunction with the unit manager to meet ongoing needs.

2 12 Lead Electrocardiogram (ECG) Page 2 of 6 GUIDING PRINCIPLES AND VALUES 1. The performance of 12 Lead ECGs serves to: 1.1. Provide information about the electrical system of the heart Document cardiac electrical activity for diagnostic reasons Assist in diagnosing myocardial infarction Differentiate and identify dysrhythmias Determine effects of drugs and/or electrolyte disturbances on the heart s electrical system PRACTICE GUIDELINES lead ECGs may be derived from continuous cardiac monitoring systems, or obtained using portable 12 lead machines. For 12 lead ECGs derived from cardiac monitoring systems, refer to equipment specific operational manuals. 2. Calibrate or standardize the ECG machine according to manufacturer s instructions. Note on the tracing any variation used for particular clinical purposes. 3. Provide adequate skin contact and accurate lead placement in order to ensure quality ECG tracings. Consider: 3.1. Anatomical landmarks for accurate lead placement 3.2. Clip hair from appropriate areas 3.3. Wash the skin surfaces with soap and water to remove oily residue and dead skin cells Do not use alcohol for skin preparation as it can dry out the skin Allowing skin to dry thoroughly before applying electrodes Changing electrodes daily, or more often if needed (for continuous monitoring). 4. Troubleshoot as necessary to ensure the ECG pattern is clear and distinct. Monitor or lead adjustments may be required to improve quality of recording. 5. Ensure documentation on tracing includes date, patient full name and medical record number, and any special circumstances such as chest pain or abnormal placement of electrodes. 6. For derived ECGs using a cardiac monitoring system, ensure: 6.1. Lead placement conforms to standard 12 lead ECG lead placement Posterior leads are recorded by moving anterior chest leads to posterior positions as per procedure.

3 12 Lead Electrocardiogram (ECG) Page 3 of 6 PROCEDURE Equipment Portable 12 Lead o 12 lead ECG requisition and addressograph labels o 12 lead ECG machine o 10 ECG electrodes Refer to site-specific operational manuals for detailed information related to: o Type of equipment available in specific units and facilities o How to locate and obtain equipment within individual facilities. o Operation of specific ECG models Derived ECG using Cardiac Monitoring System o Refer to equipment specific manual Lead Electrocardiogram 1.1. Refer to the most current edition of AACN Procedure Manual for Critical Care Place chest (Precordial) Leads using the following landmarks: V1 on the 4 th intercostal space (ICS) at the right sternal border V2 on the 4 th ICS on the left sternal border V3 midway between V2 and V4 V4 5 th ICS mid clavicular line V5, halfway between V 4 and V 6 V6 on the left mid axillary line on the horizontal level of V5 Locations of the electrodes for the chest (precordial) leads.. Goldberger, Ary L., MD, FACC - Clinical Electrocardiography: A Simplified Approach, Copyright 2013 by Saunders, an imprint of Elsevier Inc.

4 12 Lead Electrocardiogram (ECG) Page 4 of 6 2. Extra Electrocardiographic Leads (Right Precordial Leads and Left Posterior Leads applicable clinical areas only) 2.1. Refer to the most current edition of AACN Procedure Manual for Critical Care. Basic Electrocardiographic Techniques, Harrigan, Richard A., Roberts and Hedges Clinical Procedures in Emergency Medicine, Chapter 14, e1,Copyright 2014 Copyright 2014, 2010, 2004, 1998, 1991, 1985 by Saunders, an imprint of Elsevier Inc.

5 12 Lead Electrocardiogram (ECG) Page 5 of Place right Precordial Leads using the following landmarks: V 1 R on the 4 th intercostal space (ICS) at the left sternal border (same as V 2 ) V 2 R on the 4 th ICS at the right sternal border (same as V 1 ) V 3 R midway between V2R and V4R V 4 R on the 5 th ICS at the right mid clavicular line V 5 R on the right anterior axillary line on the horizontal level of V4R V 6 R on the right mid axillary line on the horizontal level of V4R V 6 V 7 V 8 V 9 LifeART Super Anatomy 7 Images, Copyright 1994, TechPool Studios Corp. USA 2.3. Place left Posterior Leads using the following landmarks: V 7 Posterior axillary line at the same level as V 4-6 V 8 Halfway between V 7 and V 9 V 9 Left paraspinal line at the same level as V 4-6 REFERENCES Jackson, K., Mayer, B., Kuksta, C., Eggengerger, T., Follin, S.A., Robinson, K. (Eds.) (2002) ECG Interpretation Made Incredibly Easy. (2 nd ed.) Pennsylvania: Springhouse

6 12 Lead Electrocardiogram (ECG) Page 6 of 6 Lynn-McHale Wiegand, D. (Ed.) (2011) AACN Procedure Manual for Critical Care. (6 th ed.)philadelphia: Saunders, an imprint of Elsevier Inc. Sendelbach, S. and Jepsen, S. (2013) AACN Practice Alert: Alarm Management. American Association of Critical-Care Nurses. RELATED DOCUMENTS Policies CC Cardiac Monitoring: Cardiac Rhythm Assessment and Telemetry Monitoring Other Learning Module - Electrocardiogram (ECG) 12 Lead * * *