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This ECG recording OSCE guide provides a clear step-by-step approach to recording an ECG, with an included video demonstration. Download the ECG recording PDF OSCE checklist, or use our . You may also be interested in how to read or document an ECG. Gather equipmentGather the appropriate equipment:
IntroductionWash your hands and don PPE if appropriate. Introduce yourself to the patient including your name and role. Confirm the patient’s name and date of birth. Briefly explain what the procedure will involve using patient-friendly language: “I need to record an ECG which is an electrical trace of the heart. The procedure will involve placing some sticky pads onto your chest and limbs. I will then connect these sticky pads to the ECG machine’s leads to record the tracing.” If the patient is a female, explain the need for a chaperone: “One of the female ward staff members will be present throughout the procedure, acting as a chaperone, would that be ok?” Gain consent to proceed with ECG recording. Adequately expose the patient’s chest for the procedure (offer a blanket to allow exposure only when required). Exposure of the patient’s lower legs and wrists is also necessary to apply the limb leads. Ask the patient to lay on the clinical examination couch with the head of the couch at a 45° angle. Check if the patient has any pain before continuing with the clinical procedure. You might also be interested in our OSCE Flashcard Collection which contains over 2000 flashcards that cover clinical examination, procedures, communication skills and data interpretation. Electrode placementA 12-lead ECG involves the use of 10 electrodes, six on the chest and four on the limbs. Begin by checking the expiry date of the electrodes to ensure they are within date. It is important to ensure each electrode has good skin contact, which may involve cleaning or shaving the areas where you need to place electrodes. If this is the case, make sure to explain this clearly to the patient and gain consent before proceeding. See below for more details on how to improve skin contact with electrodes. Chest electrode and lead placement (V1 – V6)Apply the six chest electrodes in the following locations:
Once all electrodes have been applied, attach the associated chest leads, with the cable for each lead lying inferior to the electrode (to reduce tension on the wire).
Limb electrode and lead placementApply the four limb electrodes on a distal bony prominence in the following locations:
Once all electrodes have been applied, attach the associated limb leads, with the cable for each lead lying inferior to the electrode (to reduce tension on the wire). Some people find the mnemonic “Ride Your Green Bike” useful for remembering the placement of the limb leads, starting clockwise from the right wrist.
Improving skin contact with the electrodesHair can sometimes make it difficult to achieve good skin contact and as a result, you may need to use a razor to remove the 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. Recording the ECG trace1. Turn the ECG machine on and ensure ECG paper has been loaded into the machine. 2. Double-check all the electrodes are attached in the appropriate locations. 3. Politely ask the patient to remain still and not talk during the recording as muscle activity can interfere with the ECG trace. 4. Press the appropriate button on the ECG machine to record the ECG trace. If the ECG trace is poor, double-check the connections to ensure there is good skin contact.
To complete the procedure…Once an ECG trace has been obtained, switch off the ECG machine. Detach the ECG leads from the electrodes and then remove the electrodes carefully, warning the patient this may feel uncomfortable. What should be done to prepare the room and equipment prior to an ECG?Make sure the temperature in the exam room is comfortable for the patient. If the room is too cold, the patient may shiver causing artifact or muscle tremors on the ECG. Identify the electrode sites and thoroughly shave all body hair from the electrode sites, refer to the diagram below.
When preparing a patient for an ECG leads should be placed?Suggested Lead placement. Place near right mid-clavicular line directly below the clavicle. Place near 7th intercostal space in line with or lateral to the midpoint of the left clavicle. Place near left mid-clavicular line directly below the clavicle.
What should you consider prior to recording an ECG?Before recording the ECG, checks should be made to ensure the patient's limbs are still and appear relaxed. If the patient has clenched fists or stiff arms or is moving his/her fingers, it will not be possible to obtain a high-quality ECG. Chest hair may need to be removed to ensure adequate contact with the skin.
What are the equipments required for ECG?Electrodes (small, plastic patches that stick to the skin) are placed at certain spots on the chest, arms, and legs. The electrodes are connected to an ECG machine by lead wires. The electrical activity of the heart is then measured, interpreted, and printed out.
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Describe what should be done to prepare the room and equipment prior to an ecg.
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