Artifacts
characterized by irregular spikes throughout the tracing and is related to muscle movement.
cause: Shivering or Parkinson’s Disease
Alleviate:by decreasing patient anxiety and providing warmth and comfort as needed. If patients have conditions that lead to uncontrolled muscle movement, have them lay their hands palms-down under their buttocks to reduce somatic interference.
Somatic Tremor
Universal lead wires: RA, LA, LL, and RL -what are colors
White - RA
Black - LA
Red - LL
Green - RL
Left anterior axillary line level with V4
V5
EKG machine monitors all 12 leads at once. It can record three, four, or six leads at a time and print the recording on a single sheet of paper.
Multi-Channel EKG
How fast should the EKG paper run for it to be considered a normal speed
25 mm/sec
characterized by regular spikes in the EKG tracing. It is related to poor grounding or external electricity interfering with the tracing.
Cause: Nearby electrical equipment such as lights, computers, and other items plugged into wall sockets.
Alleviate: Ensure proper grounding of the machine by using a three-prong plug, avoiding crossed lead wires, moving the bed away from the wall, and turning off unnecessary electronic devices.
AC Interference
How long does the patient typically wear a Holter monitor
24-72 hours
Between leads V2 and V4
V3
Electrodes are placed on ______ areas of the body to record heart activity from ____ angles and planes.
10 areas
from 12 angles and planes
Where do the first six recorded leads originate from
Arms and legs
results from movement associated with breathing or poor electrode connection.
Cause: The baseline will wander away from the center of the paper, causing difficulty in tracing interpretation.
Alleviate:Clean the skin before attaching the electrodes. Instruct the patient to avoid using creams and lotions.
Wandering Baseline
A portable device for cardiac monitoring that is worn for at least 24 hours
Holter monitor
Midclavicular line, 5th intercostal space
V4
EKG unit is typically found in the ambulatory care setting and records three leads at once.
Three-Channel EKG
chest hair is interfering with the proper electrode adherence to the skin- what should CCMA do?
If the MA cannot properly place the electrodes with normal skin prep, the next step is to clip the hair using surgical clippers, if available. Use regular razors only if surgical clippers are not an option, as they often cause microabrasions and tears of the skin.
obvious when there is a break in the tracing. It is usually related to a disconnected or broken lead wire.
Cause: In an interrupted baseline, a flat, horizontal line will print on the EKG tracing.
Alleviate: Regular cleaning, maintenance, and inspection of the lead wires will alert the MA to potential lead wire concerns.
Interrupted Baseline
Monitoring the heart during exercise on a treadmill or stationary bike to evaluate how the heart responds to stress.
stress testing
Midaxillary line, level with V5
V6
bipolar leads and record impulses that travel from a negative to a positive pole at specific positions in the heart.
Leads I, II, and III
unipolar leads are : aVL, aVR, and aVF
Five steps of preparing a patient for an EKG (according to NHA)
Instruct pts to remove pantyhose, tights, socks, or anything covering the feet or lower legs. A drape or gown should be worn with the opening in the front. Always ask pts if they want an additional cover for added privacy or comfort.
Remove jewelry (bracelets, necklaces), which can interfere with lead placement or touch the lead wires during the procedure.
Turn off all electronic devices, such as cell phones, and remove them from the pt. These items could lead to artifacts on the EKG tracing.
Place pts in the supine position, lying flat on their back, for the EKG. if a pt cannot lie flat on their back, elevate the head of the bed to a 45-degree angle in semi-fowler’s position.
If possible, instruct pts to avoid applying any substance to the skin (lotions, powders, oils, ointments) prior to the procedure. Help ensure the skin is clean by using alcohol wipes, soap and water at the attachment or electrode sites. Some facilities have electrolyte pads to prep the sites of electrode placement.
Produce irregular spikes (tremor)
Somatic
What are the colors associated with each precordial lead?
V1 -
V2 -
V3 -
V4 -
V5 -
V6 -
V1 - red
V2 - yellow
V3 - green
V4 - blue
V5 - orange
V6 - purple
Right of sternum, 4th intercostal space
V1
EKG machine records one lead at a time and produces a running strip.
Single-Channel EKG
What are the two most common patient identifiers used for an EKG procedure?
Patient name
Patient DOB