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Table of Contents
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.
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?”
Position the patient laid on an examination couch at 45º
Expose the patient appropriately:
There are 6 chest electrodes in total – V1 – V6
Place the electrodes in the positions shown below
Ensure good skin contact with the electrodes:
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
Place on a bony distal prominence on each limb
RED – Right 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 mnemonic “Ride Your Green Bike” a useful way of remembering this!
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
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.