EKG Ch 7

EKG Adaptations and Troubleshooting

1. Discuss artifact and identify situations that require adaptations during EKG testing

  • EKG Technician's Role: To generate a correct and readable EKG tracing, adjustments may be needed under certain conditions of the patient or environment.

  • Definition of Artifact: Artifact refers to any interference with the recording of the EKG tracing. It can arise from:

    • Environmental factors

    • Equipment issues

    • Patient conditions

  • Consequences of Artifact: Artifact distorts the EKG tracing, potentially making it impossible for healthcare providers to interpret the rhythm, which could delay diagnosis and treatment.

  • Situational Awareness: EKG technicians must adapt procedures based on patient's health status and conditions noted in patient records, such as:

    • Pregnancy

    • Amputation

    • Presence of scar tissue

Example Visuals:

  • Fig. 7-1: Compares an artifact-free normal heart rhythm with an EKG tracing disrupted by artifact.

2. Infection Prevention and EKG Testing

  • Standard Precautions: EKG technicians must use Standard Precautions with all patients.

  • Transmission-Based Precautions: Additional considerations for patients under these precautions:

    • Droplet Precautions: Wear an N95 mask before entering the room, encourage patients to wear a mask if relocated.

    • Airborne Precautions: Utilize negative pressure rooms or portable air filters; wear N95 respirators and limit opening doors.

    • Contact Precautions: Wear gloves, gowns, masks, and eye protection before entering the room; follow cleaning protocols when exiting.

  • Common Pathogen: Methicillin-resistant Staphylococcus aureus (MRSA) requires adherence to Contact Precautions.

  • Reporting Suspected Illness: Technicians should inform supervisors immediately upon noticing unrecorded symptoms of communicable illnesses.

3. Demonstrate solutions to different types of EKG artifact

  • Types of Artefacts:

    • Somatic Tremor Artifact: Produced by patient movement, resulting in a choppy distortion.

    • Causes: Tremors, shivering.

    • Solutions:

      • Positioning hands under buttocks.

      • Adjusting room temperature and providing blankets for shivering patients.

      • Reassuring anxious patients about painlessness.

  • Wandering Baseline Artifact: The isoelectric line shifts unpredictably up and down.

    • Causes: Muscle movement from breathing or poor electrode contact.

    • Solutions:

      • Remind patients to breathe normally and remain still.

      • Placing limb leads on wrists and ankles may help.

      • Improve electrode contact through proper skin preparation:

      • Remove sweat with towels.

      • Clean skin with soap and water to remove oils.

      • Abrade skin gently for better electrode gel contact.

      • Prepare skin appropriately for electrode placement to avoid wanders.

Example Visuals:

  • Fig. 7-2: Illustrates somatic tremor artifact.

  • Fig. 7-3: Displays wandering baseline artifact.

  • Fig. 7-4: Shows the use of abrading tape for improving skin-electrode contact.

4. Sources of Electrical Interference and Solutions

  • Electrical Interference: Can reduce signal quality, also referred to as AC or 60-cycle interference.

    • Causes: Other appliances in operation nearby.

    • Solutions:

    • Turn off appliances that may be causing interference.

    • Avoid using extension cords.

    • Ensure the machine is plugged into a grounded outlet.

    • Turn off fluorescent lights if they cause interference.

  • Broken Recording (Interrupted Baseline): EKG machine fails to locate a signal, resulting in a zig-zag pattern.

    • Common Cause: Frayed or broken lead wires.

    • Solutions: Check and replace damaged lead wires before use.

Example Visuals:

  • Fig. 7-5: Illustrates appropriate use of medical razors or clippers to remove skin hair, ensuring proper electrode contact.

  • Fig. 7-6: Shows an EKG tracing affected by electrical interference.

  • Fig. 7-7: Depicts a case of broken recording due to faulty lead wires.

5. Adaptations for EKG Procedures

  • General Adaptations: Changes to electrode placement or patient positioning may be needed based on specific conditions that deviate from the standard procedures.

  • Documentation of Changes: Any changes must be documented in the patient's record and noted on the EKG tracing to avoid misinterpretation by the provider.

  • Specific Situations Requiring Changes:

    • Dextrocardia: Heart points to the right, requiring mirrored electrode placement on the right side.

    • Limb Amputation/Injury: Electrodes are placed on the torso or closer to the torso if positioned incorrectly.

    • Presence of Scar Tissue: Avoid placing electrodes on scar tissue from surgeries like mastectomy.

    • Medical Implants: Electrode placement must be adjusted around pacemakers or breast implants.

    • Large Breasts: The breast tissue is positioned to allow for electrode placement on the chest wall.

    • Pediatric Patients:

    • Under 2 years old: Use right-sided EKG placement (dextrocardia adaptions).

    • Age 2-12 years: Use standard placements with minor adjustments, such as moving V4 to the right.

    • Posterior EKG: Used for diagnosing inferior wall myocardial infarctions, requiring electrodes for V4, V5, and V6 to be placed on the back.

Example Visuals:

  • Fig. 7-8: Shows right-sided electrode placement for dextrocardia.

  • Fig. 7-9: Illustrates electrode adaptation for patients with limb amputations.

  • Fig. 7-10: Depicts alternate placements around surgical scars.

  • Fig. 7-11: Provides layout for pediatric age-based electrode placement.

  • Fig. 7-12 & 7-13: Indicate posterior EKG lead placements and labeling necessity.

  • Fig. 7-14: Displays modified positioning for pregnant patients to ensure comfort and safety.

6. Troubleshooting and Maintenance of EKG Machines

  • User Manuals: Essential for understanding safety, operation, troubleshooting, and maintenance. Manuals should be accessible both in print and online.

  • Basic Troubleshooting: The EKG technician should check:

    • Battery levels

    • Paper supply status

    • Expiry of consumables

    • Verify that manufacturer instructions are followed.

  • Reporting and Handling Equipment Problems:

    • Problems need to be reported per facility procedures.

    • Place defective or out-of-service tags on faulty equipment and avoid usage until repaired.

  • Proper Maintenance: Regular cleaning, storage practices, and maintenance can minimize equipment issues and prolong device lifespan.

Chapter Review

  • Artifact and EKG Tracings: Artifact can interfere with readability and interpretation of EKGs. Several types must be recognized, including somatic tremor, wandering baseline, electrical interference, and broken recording.

  • Adaptations for Specific Conditions: Changes in patient conditions must be accommodated, including altered electrode placements for amputations, scar tissue, and pediatric patients, among others.

  • Equipment Handling: Follow manufacturers' guidelines and institutional protocols to ensure optimal operation and readiness of EKG recorders.