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ASO Lead Placement
ECG test (Prep., Position, Skin prep., Lead placement, trblsht, Post Procedure)
| Preparation | Rationale |
|---|---|
| Step 1 | Check the provider's orders |
| Step 2 | Gather machine and needed supplies |
| Step 3 | Perform hand hygiene |
| Step 4 | Introduce self to patient |
| Step 5 | Identify patient with confirmation of full name and date of birth |
| Step 6 | Explain the procedure and encourage the patient to relax, lie still, not talk, and breathe normally |
| Step 7 | Ask patient to remove all clothing from the waist up, and expose all necessary parts of the legs and arms. Provide comfort and privacy |
| Step 8 | Enter patient's data in machine |
| Step 9 | ***Place patient in supine position, head flat or raised up to 45 degrees and limbs free |
| Step 10 | ***Verbalize verbatim "If patient can not tolerate standard position for procedure, place them in an alternative position and record the use of altered position in chart" |
| Step 11 | ***For normal skin, clean with alcohol swab, let airdry, then briskly rub the skin with a 2x2 pad or dry cloth |
| Step 12 | For oily skin, clean with soap and water and dry, clean with alcohol swab, allow to airdry, and briskly rub the skin with 2x2 pad |
| Step 13 | For diaphoretic (sweaty) skin, briskly rub dry with a dry cloth, clean with alcohol swab, let airdry, and briskly rub with 2x2. Once skin is prepped, place the leads |
| Step 14 | V1 lead is placed at the 4th intercostal space, right of the sternal border |
| Step 15 | V2 lead is placed at the 4th intercostal space, left of the sternal border |
| Step 16 | V3 lead is placed equidistant (midway) between the V2 and V4, on a diagonal line |
| Step 17 | V4 lead is placed at the 5th intercostal space and the mid-clavicular line |
| Step 18 | V5 lead is placed on horizontal plane (straight line) level with the V4 lead and halfway between the V4 and V6, a.k.a. the anterior axillary line |
| Step 19 | V6 lead is placed on horizontal plane (straight line) level with the V4 lead at the mid-axillary line (midway, under the armpit) |
| Step 20 | Limb leads are placed on fleshy areas, avoiding any bony prominences and positioned in approximately the same location on each limb |
| Step 21 | The leads for the right and left arms are placed below the elbow, on the forearm at the the inside of the wrist |
| Step 22 | The leads for the right and left leg are placed below the knee, on the inside of the leg above the ankle |
| Step 23 | Once the lead wires are attached to the electrodes and an ECG is recorded, check for any problems and troubleshoot |
| Step 24 | Electrical interference can be cause by a phone, smart watch, or lights of the room interfering with the electrical equipment. I would need to check the lights, devices, cables, and grounding to ensure correction is made |
| Step 25 | Wandering baseline is caused by bad lead connection or overexaggerated respiratory movement. I correct this by making sure the leads are properly attached, being sure there's no tension on the wires, and have the patient hold their breath |
| Step 26 | Somatic tremors happen when the patient is cold and shivering, moving around, or has a disease like Parkinson's. I'd fix this by providing a blanket, have the patient sit on their hands, or try alternate lead placements with a doctor/nurse & document it |
| Step 27 | Take ECG tracing to doctor for approval before removing leads from patient |
| Step 28 | Remove leads and assist patient as needed |
| Step 29 | Perform hand hygiene |
| Step 30 | Document Procedure |
Created by:
MrsLaceUp
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