EKG on female patients

I am completing nursing school in WV which has a very conservative culture. I have found that a matter of fact manner with complete explanation step by step has worked fairly well. Maintaining coverage is something I always attempt but in some circumstances doesn't work too well. I prefer to ask the patient to lift their own breast whenever possible. I have worked in other states (CNA) and there is much less of an issue, you just do what is medically appropriate. Although seeing bed baths done with respect and coverage and with rough and rush I learned to value the impact on pts. I have had several nursing instructors who are much more concerned with accurate assessment and visualization, they just pull the curtain and whip the sheet back on males or females. With obesity it is pretty necessary to get to under breast and thigh crevasses for hygeine. I generally have a female staff member with me for anything involving touching or exposing a younger woman and ASK older women if they are comfortable. If the patient says they are not comfortable then I don't feel I am pushing my work off.

ED/ER Tech here. I couldn't agree more. I'll just pull the curtain, have them take their left arm out of their gown as I explain "I'll have to expose your left breast". I put v3-v5 under the breast. I use the back portion of by hand to lift it up. Sometimes they'll grab it and do it for me. If they're saggy, all the better, it helps hold the electrodes in place . I put v6 mid-axillary just superior to v5, per our protocols.

Again, in the ED, our primary goal is door to EKG in 5 mins for pt's with chest pain, SOB, ALOC, drug use, hx of cardiac problems or stroke like symptoms. Our docs have to sign a form confirming that no there is not ST elevation, or a Left Bundle branch block. If they circle yes, we have a whole process for cardiac cath lab. Total door to balloon time goal is <60 mins.

sorry for getting off topic, but anyways, yeah the goal is to diagnose and treat any life threatening arrhythmia's and I'm going to do what it takes to get that ECG stat, while protecting the pt's privacy as well as I can.


Jeremy

Being a male who is looking into going to nursing school... this is really something I never thought about. But I guess it's just as awkward for female nurses to do certain procedures on men.

Thats a great question, and applies to more than EKG's, but also to catheters, bed baths, etc... Obviously, only uncovering what you need to for each lead is appropriate, and asking them to lift their chest it totally exceptable. As mentioned before, if you need to lift their chest use the dorsal portion of your hand. They best way to get through this awkward portion with a patient is to be light about it, but not too jokingly. They are just as nervous and how you carry yourself will alter their feelings, so be confident, professional, and do start saying a lot of "oops, sorry" and control your facial movements. Make sure you eyes are looking at what your doing, and just tell them what your doing and why. They are more concerned about being in the hospital to begin with than having some guy moving their chest.

good god guys, they're just boobs!

I work on a Med/Surg. floor that does EKGs fairly regularly and to date I have not experienced any problems performing an EKG on a woman. I come in with a bath blanket and I provide a brief but sufficient explanation of what I am here to do, something like this.

"Hi, I'm Chris. I'm the CNA that is helping your nurse tonight. Your physician has ordered an EKG for you which is going to take a look and see how your heart is doing. For the test I need to put a few of these little leads on your chest but it only takes a few minutes and I have this blanket that we can use to help keep you covered up. Is that ok?"

If I see the patient with any sign of discomfort or objection I will ask if they would be more comfortable with a woman performing the test but most of the time they say that its fine for me to do it. I have my equipment ready and I make sure to pull the curtain and use the bath blanket for privacy. I then get my equipment set up and I start putting on my leads while I only expose enough skin to put on just the leads I'm using at the time. If I notice the patient seems a little nervous then I will ask her to lift her breast when I'm putting on any leads near the breast but if they don't appear nervous I will just explain what I'm doing and use the back of my hand to move the breast out of the way to put on the leads. I think that a huge factor is how you present yourself, you need to look like you take this seriously and that you know what your doing. If you don't appear nervous or uncomfortable then most of the time the patient isn't uncomfortable. You will have female patients that request to have a female nurse or aide and we need to do what we can to accommodate that request without judging them. Just remember that we're all here for our patients and if we can do something that will make them more comfortable then we should do that.

!Chris

I'm a long time paramedic and have never had any problems doing 12 leads in the back a medic. If you call an ambulance and need a 12 lead, you get it. I try explain it and be as discrete and quick as possible, but it's not always feasible. I have never had any complaints and people seem to know to expect it in most circumstances. I am just getting ready to start nursing school and imagine if a patient is in a hospital and needs a 12 lead done, it doesn't really matter who does it.

but certainly, opinions vary.