BEST P R AC T I C E S I N E C G R E C O R D I N G
AV O I D I N G E C G A R T E FA C T
TO R E D U C E E L E C T R I C A L I N T E R F E R E N C E :
• Switch off all non-essential electrical equipment in the immediate area. ECG read-outs can be affected by large electrical appliances (X-ray equipment, PC monitors)
• Avoid cable loops and do not run cables across the patient or adjacent to metal stools, as these act as aerials and affect the signal
• If possible, ensure that all apparatus/wall power-supplies are fitted with suppressors and that power lines are shielded
• Check that filters and pre-amplification stages on your ECG equipment are correctly adjusted
• During surgical procedures electrodes should be placed as far as possible from the electro-surgical area to minimize unwanted RF current flow
• If in doubt, consult the relevant user instructions
Baseline without recording
(or No signal)
This implies that the monitor is unable to
receive a signal
AT TA C H I N G T H E E L E C T R O D E S
• The correct placement of electrodes is typically determined by the hospital/physician and/or local protocol/procedures
• Peel the required number of electrodes away from the liner/capsule and place it on the skin, taking care not to touch the adhesive area
• The offset connector tab should be positioned in the same direction as the lead wires, towards the equipment
• Place the electrode on the skin by gently pressing around the edge. For wet gel always avoid pressing down the centre of the electrode. If in doubt refer to the directions
on the reverse of the pouch
• In the case of desiccated skin ensure the electrodes are not positioned directly over skin folds
CONNECTING THE ELECTRODES
• Connect the lead-wire from the ECG monitoring device to the electrode. If the electrode is supplied with a pre-attached lead-wire it may be connected directly to the
ECG monitoring device
• For extra reassurance stabilise the electrode lead-wires using Ambu Skin Fix, especially helpful when performing Holter and stress tests
REMOVING THE ELECTRODES
• After monitoring lift the non-adhesive corner or tab to gently remove the electrode from the skin. For NEO X/NEO use water for gentle removal.
(Refer to directions for use on pouch)
• Gel residue can be removed using paper towels or water
• The electrode is disposable and should be discarded according to hospital or physician guidelines
REASONS FOR CHOOSING AMBU BLUE SENSOR ELECTRODES
Outstanding quality - Ambu Blue Sensor electrodes are the highest quality cardiac
diagnostic sensors available. For decades, healthcare professionals across the world
have relied on Ambu Blue Sensor for consistent and accurate recordings of electrocardiac activity. Ambu Blue Sensor electrodes exceed both ISO and AAMI standards
Fast defibrillation recovery time - When a patient is defibbed, electrodes ‘absorb’
some of the electrical charge. Ambu Blue Sensor electrodes shed this extra electricity
very quickly ensuring they are able to accurately relay to the monitor what the heart is
doing
Clear and stable signals - The true offset connector reduces motion artefact and the
unique gels ensure that sensor contact with the skin is optimal at all times. Wet gel also
dramatically lowers skin impedance ensuring that ECG signals are clean and free from
base line wander
Cost effective - Ambu Blue Sensor electrodes stay on longer because of their good
quality adhesion, therefore fewer electrodes are used
* Now available is Ambu® White Sensor, the ultimate cost saving electrode for basic monitoring procedures. Now we can truly offer you the ultimate hospital-wide electrode solution.
SOLUTIONS:
• Gain control too low
• Cable break, defect in plug or
connection
• Incorrect monitor input
• Loose / Incorrect plug
• High skin impedance
• Increase gain
• Make the appropriate exchange/repair
• Select correct input
• Check plug connection
• Remove hair. Clean and gently abrade the skin
under the electrodes
• Use new electrodes
• Dry electrode gel
• High skin impedance
Zero-line fluctuation
(Baseline wander)
Frequently the patient is tense or in an
uncomfortable position and is not relaxed
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• Remove hair. Clean and gently abrade the skin
under the electrodes
• Use Ambu Blue Sensor electrode
• Re-attach electrode
• Move LL(F) electrode down
• Try to calm the patient
• Secure cable with Skin Fix
• Check earth ground
• Check plug connections
High electrode offset voltage
Skin distension artefact
Movement of the chest wall
Patient restless
Cable moving
Connection loose
• Patient is trembling or uneasy
DIRECTIONS FOR USE
S K I N P R E P.
Intended to remove dirt and dead skin cells and hence reduce skin impedance, thus enhancing signal quality:
• Shave any hairy areas, if necessary
• Gently abrade if skin impedance is too high
• Clean any greasy areas with a mild soap and water and dry thoroughly with a disposable paper towel
POSSIBLE PROBLEMS:
Jitter
This artefact is mainly attributable to the
fact that the patient is cold or nervous
Signal interruption
This is mainly due to an incorrectly
positioned or poorly attached electrode
Poor connection
The main causes are defects in
the cables or connectors
Anomalous irregular baseline
This can also be manifested in an anomalous
baseline and 50/60 Hz interference
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• High skin impedance
• Detached electrode
• Plug contact loose
• Cable break, defect in plug or
connection
• High skin impedance
• Use new electrode
• Check plug connection
• Make the appropriate exchange/repair
• Remove hair. Clean and gently abrade the skin
under the electrodes
• Use new electrodes
• Desiccated electrode gel
• Cable break, defect in plug or
connection
• Bio-electrical impulse
due to skin distension
• Patient muscular movement
• Detached electrode
• Desiccated electrode gel
• Make the appropriate exchange/repair
• Amplitude too low
• High skin impedance
• Attach electrodes further apart
• Remove hair. Clean and gently abrade the skin
under the electrodes
• Avoid if possible
• Do not lay across patient
• Not parallel to patient cables
• Increase gain
• Use new electrodes
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• Cable loops
• Power cable
• Gain control
• Desiccated electrode gel
• High skin impedance
Broad baseline
A broad baseline can occur if the cable connection
is loose or faulty, or if grounding is poor
Ensure a pleasant ambient temperature
Try to calm the patient
Use Blue Sensor electrodes with offset connector
Remove hair. Clean and gently abrade the skin
under the electrodes
• Unshielded cable
• Cable break, defect in plug or
connection
• Power cable
• Gain control
• Electrode(s) located incorrectly
• Desiccated electrode gel
Clean skin and/or remove hair
Avoid skin folds
Avoid muscle areas
Use new electrode
Attach new electrode
• Remove hair. Clean and gently abrade the skin
under the electrodes
• Use shielded cable
• Make the appropriate exchange/repair
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•
•
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Do not lay across patient
Reduce gain
Ensure correct location
Attach new electrodes
For further information please contact
Ambu Ltd., 8 Burrel Road, St. Ives, Cambridgeshire, PE27 3LE
Tel: 01480 498403, Fax: 01480 498 405, Email: [email protected]
CARDIOLOGY
®
TO R E D U C E M O V E M E N T A R T E FA C T:
• Use Ambu Blue Sensor electrodes: the true offset connector dramatically reduces motion artefact, avoiding mis-diagnosis and ensuring that vital tests need not be repeated
• Make sure the patient is sitting or lying comfortable (apart from when performing stress test)
• Shave the patient if necessary
ECG-IMAGES:
-012014UK • 06/2006 • Version 1.0 • Printed in England by Ambu Ltd. • Ambu is registered trademark of Ambu A/S, Denmark.
S TA N DA R D P R O C E D U R E :
• Read the Directions For Use
• Ensure the electrodes are within use by date
• Electrodes should be stored between temperatures of +10°C and +25°C and used within 30 days of opening the pouch
• Check that technical equipment, cables, leads and connectors are in good working condition
• Try and relax the patient
F R E Q U E N T LY O C C U R R I N G A R T E FA C T I M A G E S