ECG (Electrocardiography) The electrocardiogram (ECG) is a representation of the

electrical events of the cardiac cycle. One of the most valuable frequently used diagnostic tool. Electrocardiography displays heart’s electrical activity as

waveforms. The 12 lead ECG uses a series of electrodes placed on

extremities and the chest wall to assess the heart from 12 different views

The 12 leads consist of: Three Standard limb or bipolar leads (I, II, III) utilize

three electrodes; these leads form a triangle known as Einthoven's Triangle.

Three Augmented unipolar leads (aVR, aVL, aVF). Six Precordial unipolar leads (V1, V2, V3, V4, V5, V6).

Suctioning

Indicated for patients with any of the following: Visible presence of secretions in tube orifice Coarse tubular breath sounds on auscultation in patient

unable to cough or without artificial airway in place. Patient with an artificial airway.

Before procedure: Check chart for doctor’s order indicating suctioning for pt. Attach connective tubing to suction regulator/equipment

and inlet of suction container. Connect suction machine to vacuum wall outlet. Turn vacuum on, and occlude tip of connective tubing.

Inform the patient/family of the procedure and its purpose. Be prepared to answer any questions about the procedure that the patient may have.

Medical hand washing before procedure and patient handling should be done.

Equipment: ECG Machine, Recording Paper, Electrodes Conduction gel (Optional), Clippers, Alcohol swab or pad

Limb placement: Connect the lead wires to the electrodes. The tip of each lead wire is lettered and color coded for easy identification. The red or RA lead wire goes to the right arm. The yellow or LA lead wire goes to left arm. The black or N/ RL lead wire goes to right leg. The green or LL lead wire goes to left leg.

Chest lead placement: V1 ---- Red lead, 4th Intercostal space to the right of

the sternum V2 ---- Yellow Lead, 4th Intercostal space to the left of

the sternum V3 ---- Green Lead, midway between V2 and V4 V4 ---- Brown lead, 5th Intercostal space at the

midclavicular line V5 ---- Black lead, anterior axillary line at the same

level as V4 V6 ---- Violet lead, midaxillary line at the same level as

V4 and V5

Wash hands and apply personal protective equipment as indicated.

Adjust vacuum between -80 to -120mmHg for adults or -60 to -80mmHq for pediatrics.

Position the patient by extending the neck slightly to facilitate entrance into the trachea (especially for nasotracheal auctioning).

Open suction catheter exposing only the connector, attach to connective tubing and maintain sterility of catheter.

Fill sterile box with sterile water, and place a dab of water-soluble lubricant on sterile envelope if nasotracheal suctioning is to be performed.

Check heart rate before, during and after procedure. If tachycardia or bradycardia occurs discontinue the procedure until it resolves.

Place sterile gloves on both hands.

Remove suction catheter from envelope maintaining sterile technique. NOTE: coat tip of catheter with lubricant only if nasotracheal suctioning is to be performed.

Before procedure, remove metals, coins, jewelries and dentures from patient’s body.

Explain procedure to client. Provide client privacy. Ask the patient to lie still and not to talk and to breathe

normally and relax when recording ECG. Machines have a display screen so that you can preview

waveforms before the machine records them on paper. Press the PRINT button. Observe the tracing quality. The machine will record all 12 leads automatically,

recording three consecutive leads simultaneously. When the machine finishes recording the 12-lead ECG,

remove the electrodes and clean the client's skin. After disconnecting the lead wires from the electrodes

cleanse the electrodes as per manufacturer’s instruction. Leave to dry.

Assist the client to a comfortable position. Ensure the bed is in a low position.

Remove any remaining equipment and wash your hands. Document the procedure in Nurses notes.

If patient has an artificial airway in place, hyperoxygenate with a resuscitation bag or mechanical ventilator. If patient is receiving oxygen therapy, request several deep breaths before suctioning.

Insert the catheter through the nose or endotracheal tube to the point of restriction without applying suction. NOTE: do not aggressively force the tip of the catheter through any obstructions in the nose. Withdraw the catheter and reposition the patient's head and try again.

After the restriction has been passed, slowly advance catheter. Ask patient to take deep breaths or watch for inspiration. Pass catheter into trachea.

Once catheter has been placed in trachea, slowly withdraw while applying intermittent suction and rotating catheter. Remember: Suction should not be applied for more than 10-15 seconds.

Hyperoxygenate the intubated patient or request the non-intubated patient to take several deep breaths.

Auscultate the patient's chest; if secretions can still be heard repeat the suctioning procedure (5-10ml of normal saline may be used to loosen tenacious secretions). Before re-suctioning,

clear catheter with sterile water.