performing EKGs

[zacarias, ASN, RN]

Hey,

I'm a nurse in a teaching hospital that does maybe one EKG every couple months (we usually have a tech.) While I don't do them everyday, I am painstaking (probably too much so) about lead placement. Hopefully it's not all in vain.

I took this one woman's EKG and they all said normal sinus rhythm except the first one said septal infarct, age undetermined. The second said something else. I thought, they shouldn't be different so I printed two more after making sure the leads were pulling or whatever, and I got normal sinus rhythm, normal EKG on the last two.

I talked to a whole bunch of people and finally it was determined to just put the normal EKG, NSR one in the chart since that is the accurate one.

Now I'm thinking about all the EKGs that docs and cardiologists read that may say something is wrong but really it's not because of lead placement or movement whatever. Are cardiologists trained to dicipher this?

Any tips?

[Dinith88]

I've seen several ECG's that "say" one thing but are cleary wrong. It should be pounded into all nurses' heads to "read the ECG, not it's interpretation.." (12-lead EKG 101)

That being said, a patient could be in Sinus rhythm AND have an old septal infarction. Ischemic/infarction ECG changes have nothing to do with a patient's rhythm...they're two different animals. Did you see the QRS in leads v1 and v2? These are the 'septal leads'...if there're deep/pathological q-waves in those 2 leads, the lady may have experienced a septal infarction in the past. If the pt has small and/or benign q-waves it's probably a normal finding. The ECG might have been trying to decide if the q-waves were significant or not....or the machine might need re-calibrated...or...

Yes, Docs are trained to decipher this...and so are(should) critical care nurses (icu, er, step-down, etc). Does your place of employment offer 12-lead classes? If so, you should attend...there's lots of valuable information to be had...

The only tip i can offer is to practice practice practice...and look at as many ekg's as you can get your hands on.

But dont feel bad if 12-leads leave you in the dark...it's one of the more difficult skills to learn. It's a very usefull skill for any nurse, but critical care nurses SHOULD know how to read them.

[rockchalk_jayhawk]

At our facility we, as nurses, are trained to do EKGs. The only nurses getting experience doing them is the evening and night shifts as during the day the techs do them. We average 5 per night. As for interpretation.... Dont go by what the EKG prints out. Its a machine. It doesn't have the whole clinical picture. Ultimately the Dr. reads and interprets the EKG. I have also seen where the EKG has read NSR and there were obvious ST segment changes noted. I do agree that taking a EKG interpretation class would be benificial to any nurse that does EKGs on a routine basis. I work in ICU and we are frequently brought EKGs by the floor nurses and asked "What do you think." One more thing on lead placement. It seemed at our facility the nurses were putting the leads on differently. SO...we went with standard lead placement across the board. We have a policy in place that shows proper lead placement. Every nurse in our hospital wether RN or LPN is tought to do EKGs and have to test on proficiency at yearly competancy checks.

[bluesky, BSN, RN]

I don't know anyone who reads let alone heeds the machine's interpretation. The computer uses algorithms which simply cannot substitute for plain old good educated judgment.

[Brownms46]

rockchalk_jayhawk, I totally agree with you.

Accurate placement of the leads, and good contact does make a difference. I have also noticed that some don't make sure the sites are clean, and free of hair, prior to placing leads.

[gwenith, BSN, RN]

One of the big problems with accurate placement of course is female mammaries. And the bigger the - well you all know the problem. Not everyone is aware of all the factors that affect leads. Amount of body fat, hair and occasionally I have found people allowing the pads to contact each other (usually only on v. small adults and children they place v4 too far around and then fun out of room for v5 and v6)

I like you am a fanatic about placement and will measure out the position each and every time but I have found the pads in some really strange places.

[zacarias, ASN, RN]

Thanks all for your comments. I really shouldn't worry about it until I take an EKG class or read the EKG books I bought a month ago (when will I have time to read them?) Thanks again.

[critcarenurse16]

In our facility we routinely perform and read EKG's on the night shift. To help with the placement issue we have a picture showing placement taped to the machine. Of course do your own interpretation and correlate that with the patients clinical picture. And it doesen't hurt to get another nurses opinion- two heads are better than one when you're not entirely sure:blushkiss

[Havin' A Party!, ASN, RN]

... And it doesen't hurt to get another nurses opinion- two heads are better than one when you're not entirely sure:blushkiss

Depends on the quality of the heads, I think. :)

[newfloridaRN]

dont read what the EKG says its interpretation is.... READ IT YOURSELF! if you are doing ekg's, you should know how to read them. we had a situation yesterday where a pt was admitted for "New onset Atrial Fibrillation" (Keep in mind, I work in the ER, this is still an ER pt.)... daytime nurse comes on, reads the EKG, it SAYS A-Fib, but when she interpreted the EKG herself, it was NSR with artifact!! The doc misdiagnosed because she didn't read it herself... Did a few repeats, come to find the pt is in NSR, and never was in AF at all....