Clinical Procedures - Recording a 12-lead ECG The term '12-lead' relates to the number of directions that the electrical activity is recorded from and is not the number of electrical wires attached to the patient! Equipment • An ECG machine capable of recording 12 leads • 10 ECG leads (4 limb leads, 6 chest leads): • These should be attached to machine • Conducting sticky pads ('ECG stickers*). Procedure • Introduce yourself, confirm the identity of the patient, explain the procedure, and obtain verbal consent • Position the patient so that they are sitting or lying comfortably with their upper body, wrists, and ankles exposed • Position the stickers on the patient's body • The chest leads: • V1: 4th intercostal space at the right sternal border • V2: 4th intercostal space at the left sternal border • V3: midway between V2 and V4 • V4: 5th intercostal space in the mid-clavicular line on the left • V5: left anterior axillary line, level with V4 • V6: left mid-axillary line, level with V4 • The limb leads are often colour-coded: • Red: Right arm. (Red: Right) • Yellow: Left arm. (YeLLow: Left • Green: right leg • Black: left leg • Attach the leads to the appropriate stickers • Turn on the ECG machine • Ask the patient to lie still and not speak for approximately 10 seconds whilst the machine records • Press the button to record, usually marked 'analyse' or 'record' Check the calibration and paper speed: • 1mV should cause a vertical deflection of 10mm • Paper speed should be 25mm/s (5 large squares per second) • Ensure the patient's name, date of birth, as well as the date and time of the recording are clearly recorded on the trace • Remove the leads, discard the sticky electrode pads. Correct positioning of the chest electrodes for a standard 12-lead ECG Procedure Tips • Encourage the patient to relax otherwise muscle contraction will cause interference • If unable to relax, or access to the peripheries is difficult, the 'arm' leads can be placed at the shoulders and the leg leads at the groins • Breathing may cause a wandering baseline; breath holding for 6 seconds whilst recording may alleviate this • Ensure that you cleanse the area gently with an alcohol swab before attaching an electrode to ensure a good connection • It may be necessary to cut chest hair to allow good contact and adhesion with the chest leads • The AC mains electricity may cause interference. If this is the case, try turning off nearby fluorescent lights.
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