Deviation of lead placement even by 20-25mm from the correct position can create clinically significant changes on the ECG, including changes to the ST-segment (McCann et al. Myocardial infarctionPoor electrode placement can result in mistaken interpretation, which may then lead to possible misdiagnosis, patient mismanagement or inappropriate procedures (Khunti 2013). Accuracy in diagnosing an MI D. Single initial 12-lead ECG C. (ECGs) in the prehospital setting may improve management of patients with subtle ST-segment.ECG electrode placement is standardised, allowing for the recording of an accurate trace - but also ensuring comparability between records taken at different times.Which of the following is the dependent variable (DV) in the research question, 'Are serial 12-lead ECGs more accurate in diagnosing acute myocardial infarctions (MI) than a single initial 12-lead ECG' Selected Answer: Answers: A.Maintain good infection control practice by washing your hands prior to patient contact.Skin preparation is important. Preparing a Patient for an ECGAs with all procedures, you must obtain informed consent from the patient by explaining the purpose of the procedure, describing the procedure itself and obtaining consent to proceed. 2007).It is therefore important to not only ensure that the electrodes are placed in accordance with the standardised ‘rules’, but also, that the patient is prepared correctly for the procedure, both physically and psychologically. E ECG.Patient factors such as respiration, position, smoking, recent dietary intake and obesity may also contribute to the accuracy of an ECG reading (McCann et al. Npm install node-red-node-mysql.
Serial Ecgs Skin Is OilyEnsure the environment is at a comfortably warm temperature (Jevon 2010). If this is not possible or is uncomfortable for the patient, it is acceptable to record the ECG in another position.The patient must be completely relaxed. Care should be taken not to cause abrasions.Patients with chest hair should have hair at the electrode placement sites removed with a hair clipper (Coviello 2016).Where possible, place the patient in a supine or semi-recumbent position with their legs and arms uncrossed (QAS 2020). If the skin is oily or the patient applied any creams or lotions, use an alcohol wipe to clean each electrode placement site.Some ECG machines may also provide a ‘rough patch’ either separately or on the electrodes, which can be used to rub on the skin to increase electrode adherence.International Electrotechnical Commission (IEC) system.Both systems are described in the table below.Fourth intercostal space at the right sternal borderFourth intercostal space at the left sternal borderFifth intercostal space in the midclavicular lineLeft anterior axillary line on the same horizontal plane as V4Left midaxillary line on the same horizontal plane as V4 and V5(Adapted from Crawford and Doherty 2010a Jevon 2010 Cables and Sensors 2016) Precordial Lead PlacementNote: The following guide uses the AHA system.In order to find these correctly, the ‘Angle of Louis’ Method can be used: American Heart Association (AHA) system There are two coding systems currently in use: 12-Lead ECG PlacementThe patient’s chest and all four limbs should be exposed in order to apply the ECG electrodes correctly.There are different methods for identifying the correct landmarks for ECG electrode placement, the two most common being the ‘Angle of Louis’ Method and the ‘Clavicular’ Method (Crawford & Doherty 2010a).ECG electrodes are colour-coded, and each is identified by a specific code that refers to its intended placement. By closing the room door or drawing around the curtains. Ensure the patient’s privacy and dignity: e.g.![]() V6 is placed over the fifth intercostal space at the mid-axillary line (as if drawing a line down from the armpit). V5 is placed directly between V4 and V6. V3 is placed directly between V2 and V4. V4 should be placed in the fifth intercostal space in the midclavicular line (as if drawing a line downwards from the centre of the patient's clavicle). Next, V4 should be placed before V3. V1 is placed to the right of the sternal border, and V2 is placed at the left of the sternal border. 1998).Therefore, in female patients, the V4, V5 and V6 leads are recommended to be placed underneath the left breast where the breast tissue meets the chest (QLD DoH 2012).It is often customary in practice to write on the ECG if an electrode has been placed over breast tissue in order to aid the interpretation.Where it becomes necessary, it is also customary practice to record any alterations in lead placement for example, where lead placement is changed from the standardised location due to patient position, injury etc. Other ConsiderationsBreast tissue can impact on the ECG amplitude due to the increased distance between the electrode and the heart when ECG electrodes are placed over the chest (Rautaharuju et al. Limb Lead Placement Diagram The limb electrodes can be far down on the limbs or close to the hips/shoulders as long as they are placed symmetrically. Baille, L 2014, Developing Practical Nursing Skills, 4th edn, CRC Press, Florida. Local policies often also require the initials of the person taking the ECG to be recorded. The chest should not be left exposed and can be covered back up with blankets, or the patient can re-dress as necessary.The ECG electrodes should be removed if the patient is not likely to require further or serial ECGs, but otherwise can be left in place for up to 24 hours before needing to be replaced (Coviello 2016).If you are not interpreting the ECG, follow local policy and use clinical judgement to arrange for interpretation. Jevon, P 2010, 'Procedure for Recording a Standard 12-Lead Electrocardiogram', British Journal of Nursing, vol. 19, no. 102-8, viewed 13 March 2018, Crawford, J & Doherty, L 2010b, 'Recording a Standard 12-Lead ECG: Filling in Gaps in Knowledge', Journal of Paramedic Practice, vol. 622-29, viewed 13 March 2018. Crawford, J & Doherty, L 2010a, 'Ten Steps to Recording a Standard 12-Lead ECG', Practice Nursing, vol. Coviello, J 2016, ECG Interpretation Made Incredibly Easy, 6th edn, Wolters Kluwer, London. Get analysis toolpak for excel mac50-4, viewed 13 March 2018, Medani, S, Hensey, M, Caples, N & Owens, P, 2018, 'Accuracy in Precordial ECG Lead Placement: Improving Performance Through a Peer-Led Education Intervention’, Journal of Electrocardiology, vol. 442-8, viewed 13 March 2018, McCann, K, Holdgate, A, Mahammad, R & Waddington, A 2007, 'Accuracy of ECG Electrode Placement by Emergency Department Clinicians', Emergency Medicine Australasia, vol. Khunti, K 2013, 'Accurate Interpretation of the 12-Lead ECG Electrode Placement: A Systemic Review', Health Education Journal, vol. 17-29, viewed 13 March 2018. Rautaharju, P, Park, L, Rautaharju, F & Crow, R 1998, 'A Standardized Procedure for Location and Documenting ECG Chest Electrode Positions: Consideration of the Effect of Breast Tissue on ECG Amplitudes in Women', Journal of Electrocardiology, vol. Queensland Department of Health 2012, Adult & Paediatric Resting Electrocardiography (ECG) Cardiac Sciences, Queensland Government, viewed 10 June 2021,
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