Running the EKG and Artifact ECG Interpretation
Running the EKG
There are many manufacturers and models of ECG equipment in the field. You must refer to the equipment you use at your facility for operating instructions. Some machines have an ECG or Run button others have a 12-Lead button.
Wandering Baseline
Once the machine has printed the EKG, or it is viewed on the screen prior to printing. Inspect the image for artifact.
A wavering baseline is often referred to as wandering baseline, and it is often caused by poor skin prep or breathing in some instances.
Muscle (Somatic) Tremor
Choppy interference throughout the tracing is often caused by patient movement, even shivering or chewing gum can cause artifact known as somatic tremor.
If your patient is anxious or cold, try giving them a nice warm blanket. I have seen this work countless times.
Electrical Interference
Tight rapid oscillations seen in the tracing which looks like a caterpillar (thick and fuzzy) is a type of interference called 60-cycle or AC interference. This is electrical interference that may be caused by power cords, lighting or electrical wires in the walls, ceiling and floor. In a case like this, try to figure out the source of the problem. You may have to turn off the lights or move a power cord or in some cases change the angle of the bed (45 degrees has worked for me).
Make sure the patient is not wearing a cell phone or other electronic device and that the patient cables are within the confines of the patient.
This patient had a cell phone in their left hand.
Authors and Sources
Authors and Reviewers
- ECG heart rhythm modules: Thomas O'Brien.
- ECG monitor simulation developer: Steve Collmann
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12 Lead Course: Dr. Michael Mazzini, MD.
- Spanish language ECG: Breena R. Taira, MD, MPH
- Medical review: Dr. Jonathan Keroes, MD
- Medical review: Dr. Pedro Azevedo, MD, Cardiology
- Last Update: 11/8/2021
Sources
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Electrocardiography for Healthcare Professionals, 6th Edition
Kathryn Booth and Thomas O'Brien
ISBN10: 1265013470, ISBN13: 9781265013479
McGraw Hill, 2023 -
Rapid Interpretation of EKG's, Sixth Edition
Dale Dublin
Cover Publishing Company -
EKG Reference Guide
EKG.Academy -
12 Lead EKG for Nurses: Simple Steps to Interpret Rhythms, Arrhythmias, Blocks, Hypertrophy, Infarcts, & Cardiac Drugs
Aaron Reed
Create Space Independent Publishing -
Heart Sounds and Murmurs: A Practical Guide with Audio CD-ROM 3rd Edition
Elsevier-Health Sciences Division
Barbara A. Erickson, PhD, RN, CCRN -
The Virtual Cardiac Patient: A Multimedia Guide to Heart Sounds, Murmurs, EKG
Jonathan Keroes, David Lieberman
Publisher: Lippincott Williams & Wilkin)
ISBN-10: 0781784425; ISBN-13: 978-0781784429 - Project Semilla, UCLA Emergency Medicine, EKG Training Breena R. Taira, MD, MPH
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ECG Reference Guide
PracticalClinicalSkills.com
