7.7 Checklist: Obtain a 12-Lead ECG

*Disclaimer: Always follow agency policy and manufacturer recommendations

Checklist: Obtain a 12-Lead ECG^[1],[2]

• Verify the provider’s order.
• Obtain data related to age, gender, cardiac medications, recent blood pressure, and pain level.
• Introduce self and your role.
• Perform hand hygiene.
• Verify the client with two identifiers and check allergies.
• Explain the procedure to the client.
• Provide privacy.
• Enter demographic data as required.
• Remove oil, moisture, and/or excess hair at lead placement points.
• Open the electrode package. Check the expiration date to ensure electrodes are not expired.
• Attach four electrodes to the extremities as indicated on the electrodes.
• Attach the six chest leads in the locations described below.^[3] View Figure 7.35^[4] for an illustration of ECG lead placement.
  • V1 – Fourth intercostal space on the right sternal border
  • V2 – Fourth intercostal space at the left sternal border
  • V3 – Midway between placement of V2 and V4
  • V4 – Fifth intercostal space at the midclavicular line
  • V5 – Left anterior axillary line on the same horizontal level as V4
  • V6 – Mid-axillary line on the same horizontal level as V4 and V5
• Press the auto button and record the ECG. Ask the client to hold still while the machine is capturing the electrical activity of the heart to ensure a clear and accurate depiction of the heart’s electrical pattern.
• Inspect the tracing printout for quality. The ECG machine will provide an interpretation of the electrical activity, but a health care provider will evaluate the findings.
• If the client has an abnormal cardiac pattern, assess their level of consciousness, carotid pulse, and for complaints of chest pain or shortness of breath. Request emergency assistance if indicated.
• Remove the electrodes and clean the skin. Assess the area for redness and irritation.
• Remove gloves and perform hand hygiene.
• Provide for client comfort and safety.
• Notify the health care provider of abnormalities.