Machine Components
To set up the ECG machine properly you will need to understand its basic components.
There are several different types of ECG machine and so the setup may vary slightly from model to model, but the main principles still stand.
Display Screen
The display screen is where the processed ECG data is visually represented, typically in the form of waveforms. This screen allows healthcare providers to monitor the heart's activity in real time, facilitating quick assessments. Many modern ECG machines feature high-resolution screens that can display multiple leads simultaneously.
Electrodes
Electrodes are the critical sensors placed on the skin to detect electrical signals generated by the heart. Typically made of conductive materials, they can be adhesive pads or clips. These electrodes pick up the heart's electrical activity and transmit it to the ECG machine for analysis. Proper placement is crucial for accurate readings, and they are usually positioned on the chest, arms, and legs.
Lead Wires
Lead wires connect the electrodes to the ECG machine, facilitating the transmission of electrical signals. Each lead wire corresponds to a specific electrode and is color-coded for easy identification. The configuration of these lead wires determines the type of ECG obtained, with different setups providing various views of the heart's electrical activity. This flexibility allows healthcare providers to assess heart function from multiple perspectives.
Electrode Positioning
The electrode stickers are placed onto standardised anatomical landmarks on the body. This helps to make comparisons of the tracings consistent if they are reviewed in the future.
There are 2 main ways to set up the ECG. Either we use a standard 12 lead setup, where there are 10 electrodes attached. Or, we use three-five electrodes to perfrom continuous cardiac monitoring (shown below). This gives a continuous reading of one lead in real time and is used in emergency settings. Patients in a high care area such as CCU or HDU/ITU will often be subject to continous cardiac monitoring..
Continuous Cardiac Monitoring
Anatomical Landmarks For Positioning
12 Lead ECG
Limb Electrodes
Right Arm: Place on the right wrist or just below the shoulder.
Left Arm: Place on the left wrist or just below the shoulder.
Right Leg: Place on the right ankle or just above the right foot.
Left Leg: Place on the left ankle or just above the left foot.
Chest Electrodes (Precordial Leads)
V1: Fourth intercostal space at the right sternal border.
V2: Fourth intercostal space at the left sternal border.
V3: Between V2 and V4 (typically around the fifth intercostal space).
V4: Fifth intercostal space at the midclavicular line (MCL).
V5: Fifth intercostal space at the anterior axillary line (AAL).
V6: Fifth intercostal space at the midaxillary line (MAL).
Additional Note
Ensure the skin is clean and dry before applying electrodes for optimal conductivity.
Continuous Cardiac Monitoring
3-Lead System Electrode Positions
Right Arm: Place on the right wrist or just below the right shoulder.
Left Arm: Place on the left wrist or just below the left shoulder.
Left Leg: Place on the left ankle or just above the left foot.
5-Lead System Electrode Positions
Right Arm: Place on the right wrist or just below the right shoulder.
Left Arm: Place on the left wrist or just below the left shoulder.
Left Leg: Place on the left ankle or just above the left foot.
Right Leg (black electode): Place on the right ankle or just above the right foot (often used as a ground). It is not shown in the ajacent diagram
V1 (white electrode): Fourth intercostal space at the right sternal border. This is not shown in the diagram
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