ECG Education

ECG Education: Lessons 1 & 2

Before we begin I’d like you to answer the following questions regarding the practice of acquiring a resting 12-lead ECG.

  1. Are you a certified practitioner?
  2. Have you had regular refresher training and assessment since your initial ECG training?
  3. How regularly do you perform resting 12-lead ECGs in line with your duties?

Now think about or enquire of the person(s) that have trained you, and ask the same questions of them.

Taking a resting 12-lead ECG is the most fundamental and rudimentary part of the patients care pathway through Cardiology – and many other disciplines besides. Whether for an acute or a routine presentation, this is the test that starts the whole diagnostic ball rolling and to me this demonstrates one of the most remarkable contradictions about ECG training:

Because, for the majority:

  1. You will not be a certified ECG practitioner, and nor will your trainer.
  2. You will not have had regular refresher training, and nor would your trainer.
  3. Yet, you will perform plentiful numbers of ECGs in line with your duties.

If you and your trainer are accredited, and if you undergo regular training and assessment and are able to show this then you must be commended, because it is so important for ensuring that there is standardised practice across all centres. The Society of Cardiological Science and Technology are the professional body that accredit cardiac physiologists and cardiographers in the acquisition and interpretation of the resting 12-lead ECG, so despite any training course or ECG workshops you, or your trainer, may have done, it is the SCST accreditation that is considered the gold standard.

Lesson 1.

Accreditation, certification and training.

The training that you receive, at any stage of your career, should be measurable. You should know who is teaching you, and what qualifies them to do so. You should know that the information you receive is evidence based and accurate. Realistically asking all those that teach you what their qualifications are will probably not warm people to you, and you should be able to gauge by the position they hold what skills they are likely to be able to pass down. However, anyone that is delivering training should not mind disclosing their credentials. Those that do not, will not or can not you should perhaps be more cautious of.

Therefore, or the purpose of this training I disclose to you my level of training, practice and accreditation relevant to ECGs below:

I am an RCCP registered Clinical Cardiac Physiologist with 12 years experience working as a clinical cardiac physiologist. I am a member of the Society of Cardiological Science and Technology accredited with both my part 1 and part 2 SCST exams.  I am a practicing work based assessor – which means I regularly assess trainee clinical cardiac physiologists in all aspects of their cardiology training, and I am also an SCST examiner providing assessment at the part 1 and 2 SCST exams for cardiac physiologists and cardiographers nationally. I am on the SCST education committee and SCST council and I work at West Hertfordshire Hospitals NHS Trust as the Principal Clinical 
Cardiac Physiologist.

To fulfil all these duties I am an accredited and certified practitioner for recording resting 12-lead ECGs, as well as certified to assess those doing ECGs in the workplace, and at the professional body exam. To do this I am regularly assessed and regularly practicing.

Lesson 2.

Preparing the room and preparing the equipment.

Before I even get onto the bit about where the electrodes should be stuck, and more importantly why, I need to concentrate on the bits you need to know before you even have a patient to do an ECG on.

In order to accurately record a resting 12-lead ECG you will need to ensure you have the correct equipment available:

  1. A clean and fully functional electrocardiograph (ECG machine) should be plugged into the mains (where applicable) with its date and time set accurately.
  2. The electrograph cables and module – clean and in good condition.
  3. There should be an electrical safety test sticker on the ECG machine to demonstrate that it has been electrically tested and is safe for use.
  4. A manual for the electrocardiograph should be available.
  5. An investigation couch that is in a recumbent position, that is wide enough and long enough to support the patient’s limbs.
  6. Sufficient paper, electrodes and spare leads for the ECG machine.
  7. Skin preparation equipment, including razors, skin-friendly alcohol wipes, abrasive tape designed for skin exfoliation, gauze, tissues etc.
  8. A sharps bin.
  9. A clinical waste bin, a refuse bin, and a confidential waste bin.
  10. Disposable towelling for the bed.
  11. Clean gowns and clean sheets and a laundry bin.

You must remember that you will be asking the patient to remove all garments from their upper body and in line with this the room should be of an appropriate temperature.

The clinical area must be clean, and tidy. The investigation couch should be clean with a clean strip of disposable towelling upon it, and the ECG machine and its components should be clean and ready for use.

 

Author:

Sophie Blackman
Head of Clinical Physiology
West Hertfordshire NHS Trust
UK

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