UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: ASSISTING WITH EKGs
Effective Date: May, 2002 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
Reviewed October, 2003 March, 2005 November 2007 September 2008 January 2012
November 2013 September 2014
PURPOSE: To provide guidelines for the administration of EKG’s at University of Wisconsin Medical Foundation (UWMF) and
Department of Family Medicine (DFM) clinics.
DEFINITION: An electrocardiogram (EKG or ECG) records the electrical activity generated in the heart during the cardiac cycle. A
12-lead EKG may be ordered for a patient who has a cardiac dysrhythmia, an enlarged heart, conduction disorder, to monitor cardiac
activity or a myocardial infarction. It may also be ordered pre-operatively, as part of an overall health physical or health screening.
POLICY: Clinical staff will utilize the following guidelines to perform an EKG.
SUPPLIES: EKG machine, Electrodes/Patches, Alcohol swabs, scissors, scrub pads, Provider’s order, Patient record
1. Check provider’s order and clarify any inconsistencies in order.
2. Wash hands then gather equipment.
3. Introduce yourself; identify the patient by verifying name and date of birth.
4. Explain procedure to the patient. Instruct patient to undress from waist up; providing gown. Gown opening should be in the
front. Patient should also remove socks/stockings. Offer assistance as needed.
5. Assist patient to a supine position.
6. Attach the electrode patches:
a. Trim patient hair, as necessary, in order to provide good patch adherence.
b. Clean all ten spots with alcohol.
c. Gently scrub all ten areas with scrub pad, if needed, for patch adherence.
d. Attach the electrode patches & connect leads, avoid crossing the cables.
e. Make sure the metal side of the lead clips are in the upright position (metal side up) as they attach to the bottom of the
f. Double check your connections. Make sure leads are NOT crossed.
RECOMMENDED CHEST LEAD PLACEMENT:
V1 – at the fourth intercostal space
at the right sternal border.
V2 – at the fourth intercostal space
at the left sternal border.
V4 – at the fifth intercostal space,
at the midclavicular line.
V6 – at the level of V4
at the left midaxillary line.
* attach these last for best placement
V3 – at the midpoint between V2 and V4.
V5 – at the level of V4, between V4 and V6
at the left anterior axillary line.
7. RECOMMENDED LIMB LEAD PLACEMENT – For optimal baseline EKG reading
Optional Torso Lead Placement: If an optional lead placement is chosen, as noted in the diagram below, this
variation in the traditional lead placement must be documented on the EKG and in the progress note area; explaining reason
for choosing the torso lead placement.
8. After procedure is complete, assist patient as necessary with dressing.
9. Wash hands.
10. Review EKG result in HealthLink or hard copy. Notify provider if EKG result does not state “Within normal limits”.
11. Request that patient remain in clinic until EKG reviewed by provider if result does not state “Within normal limits”.
12. Document in patient’s record utilizing .npekg smartphrase.
WRITTEN BY: Ronnie Peterson, R.N., M.S., Manager of Clinical Support
REVIEWED BY: Eve Christoffersen, BSN, RN Clinical Staff Educator
REVISED BY: Diane Mikelsons, MN, RN, Clinical Staff Educator
ξ Kowalak, J. P. (Ed.). (2009). Lippincott’s nursing procedures (5th ed.). Ambler, PA: Lippincott Williams & Wilkins.
ξ Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7th ed.). Hall, A. & Stockert, P.A. (Eds.). St. Louis, MO: Mosby
ξ Recommendations for the Standardization and Interpretation of the Electrocardiogram, Circulation, 2007; 115: 1306-1324,
retrieved 11/1/2013 from http://circ.ahajournals.org/content/115/10/1306.full#sec-51
AUTHORIZED BY: Richard Welnick, MD, Medical Director, Ambulatory Clinic Operations, UWMF
Sandra A. Kamnetz M.D., Vice Chair, Department of Family Medicine
Medical Director, UWMF Date
Vice Chair, Department of Family Medicine Date