Performing an ECG – Best Practice

The Electrocardiogram (ECG) is one of the most widely used and useful investigations in modern medicine. It is essential in the identification of abnormalities within the cardiac conduction system. It can also help diagnose generalised disorders that affect the rest of the body.

Positioning of the electrodes must be performed to the universal standard in accordance with the AHA recommendations.

Recommendations for best practice:

  1. Explain the procedure and then obtain consent before continuing. Consider comfort and dignity, discuss level of undress, evaluate patient understanding and use a chaperone if necessary.
  2. Appropriate ECG identifiers must be used (patients name, D.O.B. Hospital/NHS number, referrer, operator, date and time) to assure the recording can be associated with the correct patient record.
  3. Patient should be in the semi recumbent position: approximately 45 degrees to horizontal is recommended.
  4. Electrode positioning: Correct anatomical chest and limb lead positions have been defined and should always be used unless access is not possible. The centre of the electrode should be aligned with the relevant anatomical landmarks.
    If any of the electrodes are to be sited in non-standard positions the recording must be labelled with this information to avoid misinterpretation of altered ECG waveforms
  5. Standard Machine settings: There are universal standard settings. These are default on each machine.
  6. Check ECG: Any features on the ECG that might indicate the need for urgent medical attention should be brought to the attention of appropriate staff. Confirmation that an ECG is of good quality aiding in the ability to interpret is essential.
  7. At the end of the procedure: Electrodes should be removed from the patient and disposed of as clinical waste.

For full guidance please see Science & Technology (SCST) guidelines – Recording a 12 Lead Electrocardiogram