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Recommended ECG Lead Placement for Surgical Patients
The placing of the ECG leads will depend on the type of surgery that is being performed. For example, with open chest
surgery the electrodes may be placed laterally on the chest or on the back. In the operating room, artifacts can
sometimes affect the ECG waveform due to the use of ES (Electrosurgery) equipment. To help reduce this you can
place the electrodes on the right and left shoulders, the right and left sides near the stomach, and the chest lead on the
left side of mid-chest. Avoid placing the electrodes on the upper arms, otherwise the ECG waveform will be too small.
WARNING
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When using electrosurgery equipment, leads should be placed in a position in equal distance from
electrotome and the grounding plate to avoid cautery. Electrosurgery equipment wire and ECG cable must
not be tangled up.
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When using Electrosurgery equipment, never place an electrode near the grounding of the electrosurgery
device, otherwise there will be a great interference with the ECG signal.
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When the monitor is connected to a defibrillator and other high-frequency devices, it is recommended to use
anti-defibrillation ECG leads, otherwise it may cause burns to the patient.
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When the monitor is used with a defibrillator, the operator should avoid contact with the patient or bed, and
the defibrillation electrode should not touch the electrode of the monitor directly, for doing so may generate
sparks then causing device damage or patient injury.
NOTE:
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If a ECG waveform is not accurate, while the electrodes are correctly attached, try to change the lead.
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Interference from a non-grounded instrument near the patient and ESU interference can cause inaccuracy
of the waveform.
A good signal should be:
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Tall and narrow with no notches.
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With tall R-wave completely above or below the baseline.
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With pacemaker signal no higher than R-wave height.
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With T-wave less than one-third of the R-wave height.
n
With P-wave much smaller than the T-wave.
To obtain a 1 mv calibrated ECG wave, the ECG should be calibrated. A message "when CAL, can't monitor!" prompts
on the screen.
Stand ECG Waveform
S
R
P
Q
T
