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ECG recording occasionally shows up as an OSCE station. It’s often feared because of the lack of familiarity with the equipment. That’s why it’s important to have plenty of hands on practice with ECG equipment prior to the big day of the exam. Check out the ECG recording OSCE mark scheme here.

Introduction

Wash hands

Introduce yourself 

Confirm patient details – name / DOB

 

Explain the procedure:

“I need to perform an ECG which is an electrical trace of the heart.”

“The procedure involves placing some sticky pads onto your chest and limbs.”

“I will then connect these sticky pads to the ECG machines leads to record the tracing.”

“I will have another member of staff acting as a chaperone during the procedure” – female patients

“The procedure doesn’t involve any electricity, so you can’t get an electric shock.”

 

Gain consent – “Do you understand everything I’ve said?  Are you happy for me to perform the ECG?”

Gather equipment

  • ECG machine to record the ECG
  • Self adhesive ECG electrodes – for attachment of ECG leads to the patient
  • Razormay be required to remove hair to provide adequate electrode contact with the skin

Electrode placement

Position the patient laid on an examination couch at 45º

 

Expose the patient appropriately:

  • A chaperone should be present for female patients
  • Remove socks from the patient to expose their ankles
  • Expose the patient’s chest

 

Chest electrodes (V1 – V6)

There are 6 chest electrodes in totalV1 – V6 

Place the electrodes in the positions shown below

Ensure good skin contact with the electrodes:

  • Chest hair can sometimes make it difficult to achieve this and therefore you may need to remove hair at the electrode site
  • If the skin is particularly oily you can clean the site with an alcohol wipe and allow to dry prior to electrode application
  • If the skin is visibly soiled it should be cleaned, ideally with soap and water, then dried prior to electrode application
  • Avoid pressing hard on the centre of the electrodes as this can cause the gel to spill outwards reducing the ability of the electrode to stick to the skin

Once all electrodes have been applied, attach the associated leads

 

Place the electrodes in the following order…

V1 – 4th intercostal space – right sternal edge

V2 – 4th intercostal space – left sternal edge

V4 – 5th intercostal space – mid-clavicular line

V3 – midway between V2 and V4  

V5 – left anterior axillary line – same horizontal level as V4

V6 – left mid-axillary line – same horizontal level as V4 and V5

 

Limb electrodes

Place on a bony distal prominence on each limb

REDRight arm ulnar styloid process at the wrist

YELLOW Left arm – ulnar styloid process at the wrist

GREEN – Left leg –  at the ankle – medial / lateral malleolus 

BLACK – Right leg – at the ankle – medial / lateral malleolus 

 

Some people find the pneumonic Ride Your Green Bike” a useful way of remembering this!

  • Position patient on an examination couch at 45°

Recording the trace

ECG machines differ significantly between hospitals and even wards.

As a result you’ll need to familiarise yourself  with the local equipment.

1. Turn the ECG machine on – ensure there is paper loaded 

2. Double check all the electrodes are attached in the appropriate positions

3. Politely ask the patient to remain still and not talk during the recording – muscle activity interferes with the trace

4. Press the appropriate button on the machine to record a trace

5. If the trace is poor, double check the connections to ensure good skin contact

  • Politely ask the patient to avoid moving or talking whilst the trace is being recorded.

Completing the procedure

1. Once a trace has been obtained, switch off the ECG machine

2. Detach the leads from the electrodes

3. Remove the electrodes

4. Thank the patient and allow them to get dressed

5. Wash hands

6. Label the ECG with the patient’s details and document your findings

If you’re struggling to read the ECG trace check out our “Understanding an ECG” article.

CONTENT REVIEWED BY

Michelle SpenceSenior nurse practitioner 

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