Nursing How To’s: Performing an Electrocardiogram

Karen, along with her classmates, watches as the staff nurse places electrodes of different colors expertly on the patient’s chest. It has always amazed her how nurses do it easily, locating where they need to put the leads. Still observing, she couldn’t help but silently hope that one day, when she becomes a Registered Nurse, she too could do such task as easily just like them. That she, too, can perform an ECG on a patient calmly and breezily. But wait, how exactly does one perform an ECG?

Steps in Performing an ECG/EKG:

  1. Inform your patient about the test and the risks involved.
  2. Ask your patient to remove electrical equipment such as mobile phones or watches that may interfere with the signal when performing the Electrocardiogram.
  3. The patient must also remove metallic objects, such as chains or bracelets, from the EKG (ECG) electrode area.
  4. Ask your patient to undress from the waist up and expose their ankles, in order to place correctly the electrocardiogram electrodes.
  5. Always ensure your patient’s modesty is not compromised by covering their torso with a bed sheet, particularly with women.
  6. Make the patient lay down in the supine position on a stretcher near the electrocardiograph.
  7. Clean and disinfect with an alcohol solution those areas in which Electrocardiogram electrodes are to be placed to ensure good attachment to the skin and a better EKG (ECG) signal.
  8. Place the EKG (ECG) electrodes on the thorax, wrists and ankles. It is important to rigorously place the Electrodes to ensure a correct reading of the Electrocardiogram.

The system of positioning of leads for performing a 12-lead ECG is universal, which helps to ensure that, when a person’s ECGs are compared, any changes on the ECG are due to cardiac injury, not a difference in placement of leads.

There are 10 wires on an ECG machine that are connected to specific parts of the body. These wires break down into 2 groups:

  • 6 chest leads
  • 4 limb or peripheral leads (one of these is “neutral”)

The six chest electrodes must be placed as follows:

  • Electrode 1 will go to the right of the sternum in the fourth intercostal space. The intercostal space is the space between the ribs.
  • Electrode 2 will go to the left of the sternum in the fourth intercostal space.
  • Electrode 3 will be in between electrodes 2 and 4.
  • Electrode 4 will go on midclavicular line in the fifth intercostal space. The midclavicular line is a vertical line that goes through the middle of the collarbone.
  • Electrode 5 is horizontally level with electrode 4 in the anterior axillary line. The anterior axillary line runs down your body from the collarbone, 3/4ths of the distance from the middle of your collarbone to the end.
  • Electrode 6 is horizontally level with electrode 4 in the mid-axillary line. The mid-axillary line runs down your side from your armpit to your waist.

Limb leads are made up of 4 leads placed on the extremities: left and right wrist; left and right ankle.

The lead connected to the right ankle is a neutral lead, like you would find in an electric plug. It is there to complete an electrical circuit and plays no role in the ECG itself.

The three active peripheral leads are AVr, AVL, and AVf.

  1. Advise your patient not to move nor speak, and to breathe normally as the EKG is being carried out.
  2. Record the Electrocardiogram.
  3. Check the Electrocardiogram before removing the electrodes. Make sure every Lead is well seen and that there are not many artefacts present. If in doubt, consult a doctor. Repeat the EKG procedure, if necessary.

Notes: Always label the EKG (ECG) tracing with the patient’s full name, time and date.Clean the electrodes from any remaining gel. Once your patient is dressed up, you can tell them when they will be informed of the Electrocardiogram report and, if possible, who will be the doctor to do so



Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

What Do You Think?