Section 1– Correct lead placement
Section 2 - Incorrect lead placement
Section 3 – Conclusion and recommendations
Recording an electrocardiogram or ECG, is a procedure which is performed daily all over the United Kingdom by thousands of healthcare workers and in particular nurses (Jacobson, 2000). The way in which this procedure is performed varies from geographical location to location and occasionally even more so, between staff on the same ward (Amos, 2000). This reason stated by Amos (2000), formed the basis of my decision to choose this topic.
The recording of an ECG is often seen as a fairly mundane, routine observation as it is non-invasive and does not physically demanding for the patient or member of staff (Cowley, 2002). However, should the leads be placed incorrectly on the patient, they may well end up with inappropriate treatment for their condition. An extensive search of the both written and electronically stored literature showed very little previous research addressing the issues of ECG performance by nurses in general wards.
The key findings as a result of this essay showed that lead placement is fundamental knowledge for all those performing ECG’s, regardless of their ability to interpret ECG’s. Section One – Introduction and correct lead placement.
For this assignment I have chosen the topic on Electrocardiograph or ECG lead placement. The purpose of this essay was to discover, based on the best and most recent evidence, whether ward nurses can adequately perform twelve lead ECG’s. In this section, a brief introduction to the problem shall be discussed along with the first aim of highlighting how the correct knowledge in lead placement is essential for all those performing ECG’s. Section Two highlights how incorrect lead placement can have an effect on patient management and Section Three offers a conclusion and recommendations for practice.
The importance of this subject to nursing is that according to Brannigan (1984), the use of continued cardiac monitoring in general ward areas is only useful if the nurse is able to detect abnormal changes of cardiac rhythm. Many of the nurses who administer the care of these patients are unable to decipher what the monitor is showing, as reported by Cowley (2002). This is where ECG’s is more useful as it is seen as a routine observation, as it is non-invasive and is not physically demanding for the patient or member of staff (Cowley, 2002).
Cowley (2002) suggests that the attachment of ECG electrodes and wires, any delays or perceived inability to interpret ECG’s competently may increase patient anxiety levels. Emphasis on the seriousness of the problem is evident due to the need for patient attachment to such a technical device. Furthermore, excess levels of circulating catecholamines released during anxiety may prove detrimental to patients with existing cardiac disease (Jacobson (2000). Prior to commencing the ECG, the nurse must introduce them self to the patient and gain consent as guided by the Nursing and Midwifery Council, (2002). According to Jacobson (2000) it is also helpful at this point to check the wristband and ask the patient for their name to rule out the possibility of having stumbled upon the wrong bed as many people will happily respond to someone else's name and have someone else's test preformed rather than point out mistakes. Jacobson (2000) also states that it is imperative that the patient is put at ease, suggesting that this is not only is it good practice, but it will improve the quality of trace obtained. Dougherty and Mallet (2000) describe how the procedure should be performed in the following steps; • Explain exactly what you are about to do with the patient’s consent. • Point out that having an ECG is a completely painless procedure. • Tell the patient a little about what an ECG does....
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