How to Take an ECG Strip - Complete Step-by-Step Guide

What Is an ECG?

Equipment You Need

STEP 1 - Prepare the Machine

1. Power on - Press and hold the Power button for 2-3 seconds until the screen lights up and the power LED turns green.
2. Check ECG paper - Open the printer door and confirm paper is loaded correctly (thermal side facing the printhead).
3. Check battery charge - If using portable, confirm the battery indicator shows adequate charge before unplugging from mains.
4. Enter patient data - Press the Patient Data button (or tap the Patient field on touchscreen). Enter:
   • Patient name
   • Date of birth
   • Patient ID / hospital number
   • Date and time (usually auto-filled)

STEP 2 - Prepare the Patient

1. Explain the procedure - Tell the patient: "I'm going to attach some sticky patches to your chest, arms, and legs and connect them to a machine to record your heart's electrical activity. It takes about 2 minutes and is painless."
2. Get consent.
3. Position the patient - Lie them supine (flat on their back) or at a comfortable 45° angle (semi-Fowler's). Arms should be flat at their sides, legs uncrossed.
4. Remove electronic devices - Phones and wearables can cause artifact/interference.
5. Expose the chest - Maintain dignity; cover with a gown or blanket between steps.
6. Skin preparation - This is critical for a clean trace:
   • Wipe each electrode site with an alcohol swab
   • If there is significant chest hair, shave or clip the area
   • Rub the skin with gauze using 5-10 firm strokes to reduce skin impedance (this removes dead skin cells)
   • The skin must be dry, clean, and oil-free before placing electrodes
   • Never place electrodes over bones, incisions, or areas with heavy muscle movement

STEP 3 - Place the 10 Electrodes

Limb Leads (4 electrodes)

AHA = American standard (used in North America). IEC = European standard. Know which color coding your machine uses.

Precordial (Chest) Leads - V1 to V6

1. Find the sternal angle (angle of Louis) - the small ridge where the manubrium meets the body of the sternum.
2. The 2nd rib attaches here. Count down to the 4th intercostal space (ICS).

V4, V5, and V6 must all sit on the same horizontal plane - do not angle upward or downward.

STEP 4 - Connect the Lead Wires

• Attach each lead wire clip to the corresponding electrode patch.
• Attach clips at the bottom of the electrode tab (inferior connection) to reduce tension and prevent tabs from peeling off.
• Ensure all 10 leads are connected - the machine will usually indicate if a lead is off.

STEP 5 - Machine Settings (Buttons to Press)

Essential Buttons / Controls

STEP 6 - Record the ECG

1. Ask the patient: "Please lie still, relax your arms and legs, and try not to talk or breathe deeply while I take the recording."
2. Watch the screen - wait for the trace to settle and become stable (no wandering baseline or jagged noise).
3. Press the ECG or Start ECG button.
4. The machine records for approximately 10 seconds automatically (in Auto mode), then prints.
5. If the trace is poor quality, do not print - check for:
   • Loose or fallen electrodes
   • Patient movement or shivering
   • Electrical interference (move away from pumps, phones, beds with motors)

STEP 7 - Post-Procedure

1. Remove the electrodes gently - peel slowly to avoid skin irritation.
2. Tear the ECG strip along the perforations (on machines with paper printers).
3. Label the strip if not auto-labeled: patient name, DOB, date, time, name of person who recorded it.
4. Transmit or file the ECG per your facility protocol.
5. Power off the machine and return it to its designated location.
6. Ensure the machine is plugged back in to charge if battery-powered.

Common Problems and Fixes

Standard ECG Paper Settings to Know

Quick Memory Aid for Chest Lead Placement

"Start at the sternal border (4th ICS), work across the chest, hug the ribcage left to the axilla."

• V1, V2 = either side of the sternum at the 4th ICS
• V4 = 5th ICS, midclavicular (think: left nipple area in males)
• V3 = fill in between V2 and V4
• V5, V6 = follow the same horizontal line to the axillary lines

ECG Machine Buttons - Visual Guide

Full Machine Overview (GE MAC 2000)

This is the GE Healthcare MAC 2000 - a standard hospital ECG machine. The color-coded lead wires connect to the 10 electrodes placed on the patient.

Close-Up: The Control Panel Buttons

Button-by-Button Explanation

The 6 Function Keys (Top Row Above Screen)

Generated Button Diagram Reference

Step-by-Step: Which Buttons to Press in Order

1. POWER button (hold 2-3 sec)  →  machine boots up
2. Function key: PATIENT DATA   →  enter name, DOB, ID
3. Function key: FILTER         →  set to standard (if needed)
4. Function key: SPEED          →  confirm 25 mm/s
5. Function key: GAIN           →  confirm 10 mm/mV
6. [Attach all 10 electrodes to patient]
7. ECG button (yellow)          →  starts 10-second acquisition + auto-prints
   OR
   RHYTHM button                →  starts continuous rhythm strip
8. STOP button (red)            →  stops rhythm strip (if needed)
9. Function key: TRANSMIT       →  sends to EHR (if required)
10. POWER button                →  shut down after use

Key Point to Remember