Performing 12-Lead ECGs

Skin Prep and Placing Electrodes - Performing 12-Lead ECGs

Skin Prep

Poor skin prep leads to unwanted artifact and not placing the electrodes where they should be can change the morphology (shape) of the waveforms the doctor is going to interpret.

The skin prep is as important as any other part of this procedure. A poor skin prep will yield poor results (artifact laden). Apply a moderate amount of pressure when prepping the skin.

I use a circular motion when prepping the skin. The intent of a good skin prep is to remove dirt, dead skin cells, oils, skin moisturizer, fake tan, body powder, sweat etc. All of these sources can lead to poor contact with the sensors and artifact.

Placement

Placement of the electrodes is very important when performing a 12-Lead EKG. When placing limb sensors, I prefer to stay away from large muscles due to the potential for movement and increased somatic tremor.

Authors and Sources

Authors and Reviewers

EKG heart rhythm modules: Thomas O'Brien.
EKG monitor simulation developer: Steve Collmann
12 Lead Course: Dr. Michael Mazzini, MD.
Spanish language EKG: Breena R. Taira, MD, MPH
Medical review: Dr. Jonathan Keroes, MD
Medical review: Dr. Pedro Azevedo, MD, Cardiology
Last Update: 11/8/2021

Sources

Electrocardiography for Healthcare Professionals, 5th Edition Kathryn Booth and Thomas O'Brien
ISBN10: 1260064778, ISBN13: 9781260064773
McGraw Hill, 2019
Rapid Interpretation of EKG's, Sixth Edition
Dale Dublin
Cover Publishing Company
12 Lead EKG for Nurses: Simple Steps to Interpret Rhythms, Arrhythmias, Blocks, Hypertrophy, Infarcts, & Cardiac Drugs
Aaron Reed
Create Space Independent Publishing
Heart Sounds and Murmurs: A Practical Guide with Audio CD-ROM 3rd Edition
Elsevier-Health Sciences Division
Barbara A. Erickson, PhD, RN, CCRN
The Virtual Cardiac Patient: A Multimedia Guide to Heart Sounds, Murmurs, EKG Jonathan Keroes, David Lieberman
Publisher: Lippincott Williams & Wilkin)
ISBN-10: 0781784425; ISBN-13: 978-0781784429
Project Semilla, UCLA Emergency Medicine, EKG Training Breena R. Taira, MD, MPH