EKG Monitoring

V1: fourth intercostal space at the right sternal border; V2: fourth intercostal space at the left sternal border.

V4: fifth intercostal space at the left midclavicular line; V3 is placed midway between V2 and V4.

V5: anterior axillary line level with V4; V6: fifth intercostal space at the left midaxillary line, level with V4 and V5.

Place limb electrodes on fleshy areas of the arms and legs, avoiding bony prominences to reduce artifact.

Normal sinus rhythm is regular at 60-100 bpm with a P wave before each QRS.

Sinus bradycardia is a regular sinus rhythm below 60 bpm; sinus tachycardia is above 100 bpm.

Atrial fibrillation is irregularly irregular with no identifiable P waves.

Asystole is a flat line with no pulse; confirm the patient, activate emergency help, and begin CPR if trained.

Somatic (muscle) tremor artifact shows fuzzy, erratic spikes from shivering or movement; warm and relax the patient.

Wandering baseline is a slow up-and-down drift from movement, respiration, or loose electrodes; secure electrodes and prep skin.

Sixty-cycle (AC) interference is uniform small regular spikes from electrical equipment or poor grounding; check cables and unplug non-essential devices.

Distinguish artifact from true rhythm changes to avoid misinterpretation.

Clean the skin, clip excess hair, and lightly abrade dry or oily skin so electrodes adhere well.

Avoid applying electrodes over lotion, oil, or thick hair, which cause poor contact and artifact.

Ensure secure electrode contact and proper lead connections for a clean, interpretable tracing.

Report significant rhythm changes and patient symptoms to the nurse promptly, as monitoring does not include diagnosis or treatment.