By Chelsea Doyle
An Electrocardiogram, or EKG, is a written graph of the electrical impulses produced by the beating heart in respect to voltage and time. This is a medical test used to diagnose heart conditions such as but not limited to irregular heartbeats, possible blockages, and wall thickening. Once the EKG is administered the machine produces a lined graph representing the patient’s heart beat. This graph is then reviewed by a Nurse or Physician. In this essay, you will be taught how to perform this diagnostic test.
A nurse or physician must first order the EKG when they feel it is necessary or beneficial to the patient. The patient should be asked if they have any underlying medical conditions or are on any cardiac medications prior to performing the test as this may affect the results. The actual electrocardiogram is a machine that is on wheels for easy transportation to exam rooms, so this must first be brought into where the patient is located. Once you are aware of past medical history, you are ready to begin.
In order to successfully perform and EKG you will need full access to the patient’s chest, arms, and legs. First, place the patient in the supine position (flat on their back with legs and arms straight out). Assess the areas you will need to attach your electrodes for excessive hair, sweat, or dirt. If a man is hairy in any or all of these areas he will need to be shaven with a disposable razor. You are never to reuse a razor on multiple patients. Also, if the patient has sweat and visible dirt the area will need to be wiped clean with an alcohol prep pad and dried fully.
You are ready to place the electrodes on the patient’s skin. An electrode is a sticker like conductor that has a small, non-sticky tab used to connect to the EKG machine. In this 12-lead EKG, you will need ten electrodes. First two electrodes (known as RA and LA to represent Right Arm and Left Arm) will be placed on the upper extremities, one on each, with the non-stick piece facing down. Best place to put the electrodes on the arms is on a bony part because the bone is a good conductor of electricity. Next apply two electrodes to the lower extremity (known as RL and LL to represent Right Leg and Left Leg), one on each, with the non-stick piece facing up. Also chose a bony part of the leg for the same reason.
Now that you have four of the electrodes placed, you will apply the final six. These six electrodes will be on the chest and will be known as v1-v6. All non-stick parts will face down. Location of these markers are very important, and if not placed properly, can negatively affect the outcome of the exam. First chest electrodes will be v1 and v2 and they belong on either side of the sternum three rib spaces down from the clavical. V1 shall be on the patient’s right side sternum and v2 shall be on the patient’s left side sternum. Now gets a bit tricky as we will skip v3 for a moment and focus on v4. V4 shall be placed on the left-fourth intercostal rib space, mid clavicular. Usually this falls about an inch or two below the nipple where the breast tissue ends. When performing an EKG on a woman, the breast will sometimes need to be lifted in order to properly place this crucial lead. Next you will apply v3 mid-way between v2 and v4 approximately half way on the edge of the breast towards the sternum. Again you will skip a lead and go to v6, which is placed under the left arm pit but following the natural curvature of the rib along the fourth intercostal space. Lastly v5 can be placed half-way between v4 and v6.
Are all your electrodes are placed successfully? Great! It is time to connect the patient to the electrocardiogram machine. The EKG machine is usually a computer screen with a built-in printer and keyboard compacted into one unit. In order to connect the patient to this machine, there is a long cord that comes out of the side attached to a small box…