Running and finishing the ECG procedure
Running the ECG tracing
Once the lead wires are attached to the electrodes, the medical assistant enters the patient information into the ECG machine. In some facilities, this may be done prior to bringing the patient into the room for the ECG. Typically, the patient’s name, date of birth, and medical record number are entered. Facilities will have additional information that they require to be entered, such as the ordering provider’s name and the provider reading the ECG.
Chest leads in the Intercostal space, I C S. The parts labeled are marked clockwise as follows: xiphoid process, sternum, clavicle, midclavicular line, mid axillary line, anterior axillary line, I C S, second I C S, third I C S, fourth I C S, fifth I C S, v sub 1, v sub 2, v sub 3, v sub 4, v sub 6, v sub 5.
After the information is entered, the medical assistant should remind the patient to remain still and not talk during the procedure. It usually takes a minute or less for the tracing to be created with a multichannel machine. Talking and movement will create artifact. Use a blanket to cover the patient who is cold.
Prior to running the tracing, double-check that all the electrodes are attached, and the lead wires are in the correct location. If the ECG machine has a screen, check the digital picture of the leads. Are they clear (without artifacts)? If not, is the filter(s) on? Are the leads (pictures) an equal distance from each other? Is the baseline horizontal, or is it moving up and down like a roller coaster? Do not run the tracing until it is clear, and the baseline is horizontal.
Single-channel and multichannel ECG machines
ECG machines can be single-channel or multichannel. In single-channel models, the machine contains one amplifier channel and one recording stylet. The single-channel machines record one lead (picture) at a time. The medical assistant must manually switch to the next lead until the procedure is done. When these machines are used, the process of recording a tracing takes up to 3 to 5 minutes. Single-channel machines can use paper rolls or Z-fold paper. These small strips of paper need to be mounted.
Multichannel machines monitor all 12 leads. This model has several stylets that allow for four groups of three leads to be traced every few seconds. With some machines, a fourth stylet traces one lead for the entire width of the page. Typically, the multichannel machines print the tracing on 8.5 × 11-inch or Z-fold paper.
Finishing the ECG procedure
If the ambulatory care facility uses an EHR system and the ECG machine interfaces with the EHR software, then the medical assistant should follow the procedure and upload the tracing to the patient’s health record. The provider will read the tracing once it is uploaded.
The provider must read the ECG before it is filed in the paper medical record. If the tracing was done on small strips of ECG paper, the strips need to be mounted per the facility’s procedures. Special 8.5 × 11-inch paper with adhesive strips is used to stick the ECG tracing strips. Once the strips are mounted, they can be given to the provider to read. If the ECG prints on 8.5 × 11-inch paper, it does not need to be mounted. It can be given to the provider immediately.
If an artifact appears on the screen, identify its cause and fix the issue before printing, or redo the tracing if it already printed. The Troubleshooting and evaluation chapter covers additional problem-solving strategies for artifacts such as AC interference and reversed leads. Once the tracing looks good on the screen, print it.