EKG on female patients

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How do all of you do EKGs on female pts? I've been using a towel folded longwise to cover their breasts. My big concern is placing electrodes and connecting the leads when they are large and a bit saggy. Do you ask them to lift themselves? I work in an ER and many times I simply cannot get a female to do the EKG in a reasonable time frame.

Specializes in Pysch, SN, Med-Surg.

All i can say is, lololololololololololol. And people say nurses have it easy?.....

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Specializes in Cardiac/ED.

When I performed EKG on females I always used a towel across the chest and when moving a breast for placement I used the back of my hand with the lead between my thumb and index finger...one smooth one handed motion...move the breast and place the lead...all done!

Answer to leave the bra on and get good EKG...I had my patients at least un-hooked the bra so that it could be moved out of the way.

I always prided myself that my patients could ask a complete stranger in and have them stand at my shoulder and they still wouldn't have seen anything...now I did not do that but they could have if they wanted.

Just my 2 cents.

P2

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1776patriot said:
Is it possible for the female patient to leave her bra on during the EKG and still get a good reading?

YES!

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I'm an EKG tech myself. When I first started, I was kind of nervous about doing the females, but now I don't even really think about it. If the breasts are big and in the way, I have found that it's best to just ask very casually and yet respectfully & professionally: "Would you mind lifting your left breast up a little?....perfect - thanks!" If the patient is unconscious or in too much pain to move, I'll just tell her what I'm going to do, and lift the breast up myself. It's easier to do so by cupping the breast in your hand, obviously - but sometimes I'll even just gently push up against the breast with the back (non-palmar) side of my hand. That's just my way of being clear that I'm not trying to "grope" her. I've found that in-patients, esp if they are older females and/or in ICU - are very used to being poked and prodded, so they don't seem to mind that much. However, I have seen some of the younger patients (below 50 or so) and/or outpatients suddenly tense up a bit and sort of give me the "cold shoulder" when they realize that I'm going to have to work around the breast. But I just try to be as polite and professional as I can. Occasionally, I have seen some women who, when they realize that I'm done, immediately start reaching for the electrode stickers and taking them off herself. And I don't mind at all, when that happens; I'll just let them do that, but maybe still offer to help take off the arm and leg leads. If they have a bra on, I've found that I can usually work around it - although I often have to ask her to lift it up a little from underneath. If they are in a gown, I try to just keep her covered as much as possible, but still do what has to be done to get the EKG, and sometimes that inevitably involves some very brief exposure. I have done EKGs in outpatient, pre-surg, ICU...pretty much everywhere, over the last 2 years. I can only think of one time that I've ever had a female just outright protest about me doing the EKG. And when that happened, a female nurse happened to be in the room, and she explained why I was having to do the EKG and just talked her through the procedure. There have also been a few times when they have been seemingly a little too eager to take their gown off! But I always just try to be as utmostly polite and professional as I can, regardless of the circumstances.

I can tell you one thing: I've heard countless stories from my female EKG-tech coworkers about them having trouble with female patients not wanting to expose themselves, and/or even being rude, making little comments, etc. So if/when a female patient ever does act in this way, it may well be that it's more of her own issue with being exposed, and not necessarily just because of the fact that a male is in the room. Obviously, it's just a natural and normal response to having to be exposed. I just try to keep it low-key and as "painless" and quick as possible.

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Specializes in Telemetry, ICU, Psych.

I've replied in another thread, but the main point...

We should be respectful, but - in an effort to maintain decency - getting a clear EKG is the primary goal. When I worked in the ER I would see HORRIBLE EKGS that were done. I would walk into the room and see a completely clothed female with leads underneath her shirt. I would remove the clothing and repeat the EKG. This could mean the difference for thinking someone is in Sinus tach with a few PVC's and new onset atrial fibrillation. On my tele floor, we get EKGS to help verify/capture what the tele monitor is spitting out. Accuracy is very important.

I do respect a patient's privacy and understand their psychosocial needs. But an accurate cardiac assessment and EKG can mean the difference between life and death. I calmly explain what I am doing, ask for permission, and generally expose the patient. I have never had a problem, and my EKG's are usually right on. I didn't feel this way as a tech, but as a tele nurse my license is on the line and many of our doctors treatment is based upon (in addition to other factors) EKG results.

CrazyPremed

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i wanted to add my since i have recently experienced a ekg and a cardiac visit. overall it is the only nursing facility i have been at the everyone was extermely nice and friendly. a young nurse did my ekg, she was quite and there to do her job type. she did do a good job keeping my covered. she was probably the least friendly, but still extremely professional and nice.

my doctor was a man who was extremely professional, nice, friendly, and respectful to me. he listened to my heart probably x 20 places or times. i was really impressed on the care and time on me. he enquired about my health, life, and educated me about where he was listening and what for d/t i am a student. i was very impressed. he basically used his stethoscope to move my breasts, which was fine, b/c he was gentle.

overall, i liked the basic chat previous to it, half explanation even though i was in my scrubs and they knew i was a student. it made me relax. the back of the hand trick is what i had learned in school. it is funny how being a pt is so much diff then being a nurse. your eyes are focusing on everything else.

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Specializes in Critical Care, Progressive Care.
bill4745 said:
How do all of you do EKGs on female pts?

I do this all the time in the clinic (as a medical assistant).

1. Explain procedure.

2. Provide pt with warm bath blanket (we don't have gowns) as drape, turn you head and eyes away from the pt when draping.

3. Always keep pt draped - expose only the area needed. Keep drape over as much of breast as possible when placing v4 and v5.

4. Move breast up using the back of the non-dominant hand (ie NOT the palm), place leads quickly, remove hand, replace drape.

5. Work quickly (not rushed - get the leads in the 5th intercostal space, but work at a businesslike pace), confidently, and professionally.

Women that have had an EKG before know the drill, so it is much less of deal than you might imagine. I have to laugh when an earlier poster mentioned the lols that whip off their clothes for you to "have at it." Happens all the time . I cover them with a warm bath blanket saying it will "keep you warm" - this is always greatly appreciated.

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Specializes in Critical Care, Progressive Care.

This reminds me of my mother - she went to a Catholic Hospital SON back in 1958 through 1961 (RN diploma nurses in those days went to school for 3 years, providing a significant amount of uncompensated labor to the hospital).

In any even, Mother relates that Sister Joseph taught her how to give a bed bad to male patients:

"I can remember it like it was yesterday. Sister Joseph told us that we are all made in the image of God and that when we needed to 'finish' the bath on a man we were to drape 'the area,' lift our eyes to heaven, reach under the drape and quickly wash 'the area' without looking at it."

One wonders if this strategy was designed to protect the modesty of the patient or the virtue of the student nurse.

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bill4745 said:
How do all of you do EKGs on female pts? I've been using a towel folded longwise to cover their breasts. My big concern is placing electrodes and connecting the leads when they are large and a bit saggy. Do you ask them to lift themselves? I work in an ER and many times I simply cannot get a female to do the EKG in a reasonable time frame.

One of our new techs (a guy) was in doing an EKG on my chest pain patient, and I guess I'd never paid attention to how he does them but I was impressed. To be quite honest, in the ER I work at chest pains are addressed so fast and furiously to meet our time goals that a lot of times, the boobs just end up on display for about 3 minutes due to wanting to get that EKG done in under 10.

Once the patient is in a gown, he takes and pulls the sheet up to their belly button, pulls the gown up and kind of folds it and has it still resting on the top of their breasts, and applies stickers/attaches leads from under (as opposed to pulling the gown down and exposing breasts)... so of course they get uncovered slightly to apply leads/stickers but otherwise have much better privacy than most.

Hope that helps!

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Specializes in Trauma, Neuro, M&S ICU.

I am currently a tech, in our ER and perform 10-20 EKGs on an 8hr shift. I pull the top down over the shoulers, and call it the "sexy look" to place the arm and 1 and 2 leads, then pull up on the side, but keep the left breast in a little pocket of the gown and use the top of my hand to "LIFT" as I place 3-6. Seems to work well and it keeps then covered. Professionaly it is nice when they are not as modest, then I can get them done faster. My ER is the sought after for CVA and STEMIs so that helps for speed too.

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Specializes in icu/er.

will place 3 lead on without trouble, will get female nurse or tech to place 12 lead, unless it's emergent situation. i dont want the hassle, and you dont eatheir..

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Specializes in Cardiac/ED.

My only problem with getting females to do your 12 leads is that by constantly pushing your work onto females it encourages those who believe that men should not be in the nursing profession.

I have say that I feel that you might be setting us back a few places as far as men in nursing, as men we may be scrutinized more closesly for these particular procedures but we should maintain our professionalism as we forge ahead with accomplishing our job by utilizing good proper technique to stay ahead of those that will question.

I bet if you ask those females that you have to ask to do that work I'll bet you'll find that they don't like the fact that you ask them to do that all the time.

P2

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