3M Red Dot Electrodes ™ ™ Factors Affecting ECG Trace Quality Monitor •C MRR (Common Mode Rejection Ratio) used to separate ECG from other signals • F ilters • B andwidth (frequency response) • A mplifier noise •G round loops Skin Electrodes • Impedance • A dhesion •D iaphoresis •C onductor •D ryness •G el •O ilyness • B acking • E MG, respiration and other biopotentials (physiological electrical signals) • S ize • S aturation distortion (e.g. defibrillation recovery) • S kin preparation techniques • Input impedance • S kin stretch •D ifferential input (required to generate ECG tracing) •M otion artifact •O besity Environment • E lectrical field (60 Hz) •D esign •M otion • S helf life • A pplication technique • E lectrical/mechanical properties • L ocation on the body Cables & Lead Wires •H umidity •M echanical/electrical properties of materials • T emperature • Shielded cable and shielded lead wires • S tatic electricity •O pen lead wires (avoid loops) •M agnetic field • T riboelectric effect (generated by cable movement) • R adiofrequency • Vicinity of other machines (nebulizers, fans, power cords, etc.) 3 3M Red Dot Electrodes ™ ™ Proper ECG Electrode Placement 3-Lead Placement 5-Lead Placement Monitoring Electrodes RA 12-Lead Placement Monitoring Electrodes LA RA Resting Electrodes LA V2 LA RA V1 V2 V3 RA: Second intercostal space lateral right side LA: Second intercostal space lateral left side LL: Lower left lateral chest or left leg RL LL RL LL RA: Second intercostal space lateral right side LA: Second intercostal space lateral left side LL: Lower left lateral chest or left leg RL: Lower right lateral chest or right leg V2: Fourth intercostal space to the left of the sternum LL RA: Second intercostal space lateral right side LA: Second intercostal space lateral left side LL: Lower left lateral chest or left leg RL: Lower right lateral chest or right leg V1: Fourth intercostal space to the right of the sternum Troubleshooting ECG Traces Troubleshoot each artifact in order, starting with Artifacts Skin Impedance AC Noise Muscle Movement Low Amplitude Electrical Continuity Electrodes Cabling Interference Equipment 2 4 3 1 Check all connections/perform continuity check Check for dry-out Check for proper cable Check lead switch and ECG machine set-up 3 1 2 4 6 5 Abrade skin Stop patient movement Check ground connections Use same type of electrode at all sites Check for proper cable Check for static build-up 3 6 1 5 7 2 4 Abrade skin May be untreatable involuntary muscle tremor Check ground connections Check for dry-out May need fully shielded cable and lead wires Keep cable away from AC cord Turn off fluorescent lights and/or other equipment Intermittent Signal Motion Artifact V2: Fourth intercostal space to the left of the sternum V3: Between V2 and V4 V4: Fifth intercostal space along the mid-clavicular line V5: Fifth intercostal space between V4 and V6 V6: Fifth intercostal space along the mid-axillary line 1 No Base Line Base Line Wander V4 V5 V6 1 2 4 3 Check for loose connections Check for loose electrode or dry-out Perform continuity check Check for static build-up 2 1 3 4 7 5 6 Abrade skin Move electrodes off muscle mass Check for loose connections Check for loose electrode or dry-out Perform continuity check Turn off fluorescent lights and/or other equipment Check for proper EKG machine set-up 3 1 4 5 2 Abrade skin Check all connections Check for dry-out Turn off radio, TV and/ or other equipment Check gain settings 3M Health Care Infection Prevention Division 3M Center, Building 275-4E-01 St. Paul, MN 55144-1000 USA 1-800-228-3957 www.3M.com/reddotelectrodes 3M and Red Dot are trademarks of 3M. Please recycle. Printed in U.S.A. © 3M 2014. All rights reserved. 70-2009-1505-9 HB9674
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