Basic EKG Procedures: Quick Reference Guide

Patient Identification and Preparation
  • Identification: Verify patient using two identifiers (full name, date of birth) from their statement, cross-referencing with provider's order and wristband. Do not state patient's information for confirmation. Do not use address or room number.
  • Communication: Use facility-approved interpreters for non-English speakers; family/friends should not interpret medical information.
  • Infection Control: Apply Standard Precautions for all patients. Use gloves if contact with non-intact skin or body fluids is likely; masks for respiratory illness.
  • Skin Preparation: Observe skin before electrode placement; a clean, dry surface ensures proper adhesion. Avoid open sores, scars, and implanted devices like pacemakers.
  • Emergency Response: EKG technicians must recognize and respond to emergency situations during testing according to facility procedures.
12-Lead EKG Test
  • Purpose: Used for screening and diagnosing suspected heart problems.
  • Patient Reassurance: Inform the patient the test is painless and brief. Use simple language for pediatric patients (e.g., "stickers" for electrodes).
  • Procedure Overview: Identify patient, wash hands, explain procedure, prepare patient (undress waist up, gown, remove jewelry/socks as policy dictates), position supine. Prepare skin (dry, clip hair). Attach electrodes to lead wires, then to correct positions on patient (avoiding bony areas, broken skin, implants). Instruct patient to stay still, print EKG, check for critical abnormalities, disconnect wires and remove electrodes, document, and clean equipment.
Telemetry Monitoring
  • Purpose: Continuously monitor heart rate and rhythm over 24−4824-48 hours or longer using a small wearable device (telemetry pack).
  • Application: Prepare skin for electrode adhesion. Attach electrodes, then connect wires to the telemetry pack. Confirm unit functionality with the monitoring room.
  • Patient Instructions: Instruct patient not to remove electrodes/wires, keep the monitor dry, continue normal activities, and notify staff if electrodes become loose.
Stress Test
  • Purpose: Measures heart function under controlled stress to assess heart health, predict future issues, or plan procedures.
  • Types: Exercise (treadmill/bicycle), Pharmacologic (medication-induced stress), Nuclear (uses a radioactive tracer).
  • Patient Preparation: Avoid caffeine for 2424 hours, follow medication instructions, fast for 33 hours (except water), wear comfortable attire, and bring all medications.
  • Target Heart Rate: Patient must reach 85%85\% of their age-predicted maximal heart rate for a valid test.
    • Age-predicted maximal HR: 220−patient’s age220 - \text{patient's age}
    • Target HR: (Age-predicted maximal HR)×0.85(\text{Age-predicted maximal HR}) \times 0.85
  • Safety and Cessation Criteria: Conducted by CPR-trained staff with oxygen, AED, and crash cart ready. Stop the test immediately if the patient experiences: dizziness, chest pain, shortness of breath, significant BP changes (systolic $> 250 \text{ mmHg}$, diastolic $> 115 \text{ mmHg}$), leg cramps, severe fatigue/diaphoresis, ST segment changes, dangerous dysrhythmias, patient request to stop, or heart rate fails to exceed 120 BPM120 \text{ BPM}.
  • Post-Test: Monitor patient until vital signs return to baseline; advise rest and avoidance of stimulants.
Ambulatory Monitoring (Holter)
  • Purpose: Evaluates cardiac activity during daily routines, typically for 24−4824-48 hours.
  • Electrode Adhesion: Prepare skin by cleaning/abrading to ensure electrodes stick properly. Use fresh batteries.
  • Stress Loop: Create a stress loop with lead wires using a built-in clip/slot or tape to reduce tension from patient movement, thereby improving recording quality.
  • Patient Education: Provide instructions including not removing leads, keeping the monitor dry (no bathing/swimming), continuing normal activities, maintaining an activity/symptom diary (with event button use), calling 911911 for severe symptoms, and returning equipment.
Record-keeping and Patient Confidentiality
  • Accurate Documentation: EKG tests must be correctly documented and uploaded to the patient's Electronic Health Record (EHR) to ensure availability and accuracy. Always verify the correct patient chart.
  • Protected Health Information (PHI): All patient health and identifying information (name, address, SSN, EKG results) is confidential and protected by federal laws like HIPAA (Health Insurance Portability and Accountability Act) and HITECH Act.
  • Security: EHR systems use usernames and passwords. It is crucial to keep passwords secure and log out after use.
  • Sharing PHI: PHI can only be shared with care team members involved in the patient's care or individuals with a legal right to know. A signed patient release form is required for sharing information outside the facility.