CCMA · EKG and Cardiovascular Testing · 7 min read
Patient Preparation and EKG Artifact Troubleshooting
- Prepare the patient physically and emotionally for a standard 12-lead EKG while maintaining modesty, comfort, and safety.
- Perform proper skin preparation and apply positioning adjustments for patients with specific clinical needs.
- Identify, prevent, and troubleshoot the four major EKG artifacts within the clinical medical assistant's scope of practice.
Patient Identification, Communication, and Privacy
Before beginning any clinical procedure in an outpatient setting, the medical assistant must verify the patient's identity using at least two unique identifiers. This fundamental safety step confirms that the diagnostic procedure is performed on the correct individual. Once identity is confirmed, the medical assistant should explain that an EKG is a noninvasive test that records the heart's electrical activity and is generally painless, although skin preparation or electrode removal may cause minor discomfort. Reassure patients that the electrodes detect electrical signals at the skin and that a standard EKG does not deliver a shock; the tracing can also pick up muscle activity and electrical interference.
Clear instructions regarding clothing, personal items, and electronic devices help ensure a smooth procedure without unnecessary delays. The medical assistant should ask the patient to remove or adjust clothing, jewelry, watches, or other personal items that directly obstruct electrode placement or come into contact with the lead wires. However, the routine removal of belts and pocket coins is not necessary for an EKG. Similarly, while mobile phones and other electronic devices should be moved away from the EKG cables if they produce interference, patients do not routinely need to power off their devices.
Maintaining professional boundaries and personal dignity is a core duty during diagnostic testing. The medical assistant must provide an examination gown and expose only the chest and the specific arm and leg sites needed for electrode placement. Patient modesty must be preserved throughout the entire encounter by providing a gown and covering exposed areas with a clean sheet or drape. For example, just as a clinician draws a curtain and covers a patient during an abdominal exam, an assistant performing an EKG keeps the patient's lower body draped, uncovering only the anatomical landmarks required for the procedure.
Common mistakes
- Use clippers when possible to reduce skin irritation; if shaving is necessary, follow facility policy and protect the skin.
- Assuming an alarming rhythm tracing is merely an artifact without first looking at and assessing the clinical status of the patient.
- Routinely requiring patients to remove belts, remove coins, or power off their mobile phones when no interference or obstruction is present.
- Attempting to independently interpret dysrhythmias or failing to document table position changes and persistent artifacts for provider review.
Key points
- Verify patient identity using two unique identifiers, reassure the patient that an EKG is painless and delivers no electricity, and preserve modesty with appropriate gowning and draping.
- Position the patient supine with arms flat and legs uncrossed; raise the head of the table for shortness of breath or orthopnea, or use a slight left lateral tilt during late pregnancy, documenting all adjustments.
- Prepare the skin by cleaning with alcohol or soap and water, drying thoroughly, gently abrading with dry gauze, clipping hair, and discarding expired or dried electrodes.
- Troubleshoot somatic tremor by warming shivering patients and relieving tension, and correct wandering baseline by securing loose electrodes, cleaning skin, and relieving cable tension.
- Reduce 60-cycle AC interference by keeping lead wires away from power cords and routing them along body contours; report persistent equipment or grounding problems according to office policy, and address interrupted baselines by securing connections or replacing damaged wires.
- Always assess the patient immediately if a tracing suggests a life-threatening dysrhythmia, promptly alert the provider, and never attempt to diagnose or interpret rhythms independently.
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Sample lesson: Electrodes, Leads and 12-Lead Placement25 practice questions on this exam
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