Performing an ECG – Best Practice

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

Electrode positioning is universal and must be positioned in accordance with AHA recommendations.

In essence for best practice:

  1. Ensure suitable environment: Accessible, clean, private, quiet and comfortable.
  2. Obtain consent and explanation of procedure: Consider comfort and dignity, discuss level of undress, evaluate patient understanding and use a chaperone if necessary.
  3. ECG Identifiers: Patient name, D.O.B, Identifying number, referrer, operator, date and time of recording.
  4. Semi recumbent position: Approximately 45 degrees to horizontal is recommended.
  5. Skin preparation: Needed to produce an artefact-free ECG (Care must be taken with patients who have sensitive or broken skin).
  6. Electrode positioning: Correct anatomical chest and limp 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
  7. Standard Machine settings: There are universal standing settings. These are default on each machine.
  8. 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 of good quality.
  9. 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