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Pre-procedure preparation

In the first of a series of videos, Clinical Simulation Specialist, Jasmine Burnett, talks us through the pre-procedure preparation of a ECG recording
Before or after any contact with a patient, it is important that you wash your hands or apply alcohol gel to clean your hands. Good afternoon, how are you? Fine, thank you. Hello, my name is Jasmine. I’m your nurse today. Could you just tell me your name please? Mark Collins. Lovely. And your date of birth? Twenty-fourth, 1st, 55.
Excellent. And obviously I can see your hospital number here. Are you allergic to anything at all, Mark? No. Excellent. No problems with sticky gel or plasters in the past? No. Excellent. I’ll be doing an ECG on you this afternoon, which is a recording of the electrical activity of your heart. In order for me to do so, I’ll need you to just to undress from the waist up, and then I’ll just expose your ankles maybe a little bit more. Is that all right with you? Yes. That is fine. OK. Would you like anybody else in terms of chaperones to be present while we do this procedure? No. Thank you very much.
Now, in terms of preparing the patient for the ECG, it is important that the environment is quiet, comfortable, and as private as possible. So drawing any curtains, closing any doors, closing any neighbouring blinds just to minimise any distraction or lack of privacy for the patient. And then you need to make sure your patient is comfortably positioned. So you can see I’ve used a couple of pillows here to support Mark into the correct position, and we’re ideally looking for a position of about 45 degrees in terms of angle. That, I’m aware, is not always possible in clinical situations.
There may be some patients who are wheelchair bound, and we’re not able to actually alter their position in this manner, but you will need to make sure whatever position the patient is, if it’s away from the normal considered position, that it’s noted on the ECG, so the person who’s interpreting it will aware of the altered body position. Before performing your 12-lead ECG, you would need to check your machine, have a little look to make sure that it has been recently serviced and it’s within date.
You’d want to position it to the left-hand side of your patient, ensure that it’s plugged into the mains, and then you want to have a little look at the ECG cable itself, make sure there’s no breaks in the plastic sleeving and to make sure the clips are in good clean serviceable condition and they’re all present so actually when you expose your patient, you can actually complete the task that you’ve started. Now, in terms of skin preparation for your patient, there’ll be a couple of things you’ll need to do before applying your electrodes.
One of the things that’s a common barrier to getting a good quality ECG is oil on the skin, so detergent wipes, or soap and water wipes, are perfect for cleaning the skin in the first instance. Should your patient actually have applied moisturiser to the skin on the day of the proceedings or has actually got quite a lot of hair on their skin, you may want to secondarily follow it with some alcohol wipes. Again, that would further clean the skin and remove any excess moisturiser or lipid barriers there. In terms of physically removing hair in male patients, there are a range of options, disposable razors being the first line.
You should also have those, and in some troughs or its working environment, you might find you have a pair of electric clippers that might be an alternative option to you. But whatever you elect to use in terms of cleansing the patient’s skin, you must ensure that you thoroughly dry the skin using some gauze thereafter. You would like to make sure the skin is thoroughly dry to encourage the adhesion and good electrical contact from your ECG electrodes.

In the first video of our ‘How to record an ECG’ series, Clinical Simulation Specialist Jasmine Burnett talks us through the important stages of pre-procedure preparation for a standard ECG recording.

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ECG Assessment: an Introduction for Healthcare Providers

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