During the ECP therapy patient preparation plays a very important role, preparing the patient by properly securing the cuffs and proper placement of ECG electrodes ensures a good and trouble free ECP therapy. In this section we would discuss about the proper placement of ECG electrodes for an effective ECP treatment.
Selecting the electrodes
Pregelled silver/silver chloride electrodes are recommended. Using electrodes of dissimilar metals can prevent obtaining a good ECG trace required for 'IECP' Increased External Counter Pulsation therapy.
Choose Proper electrode site on the patient
Increase muscle artifact due to patient movement greatly affects the ECP monitoring. Place Electrodes in flat areas; avoid fatty or bony areas and avoid major muscles.
Prepare electrode site
Shave hair (If any) from the electrode sites.
The ECG cable and electrodes should be checked for damage on a regular basis and replaced as necessary.
In areas where electrodes will be attached, thoroughly clean skin and lightly rub dry. You may use isopropyl alcohol or special skin preparation pads.
To avoid allergic reactions to electrodes, refer to the electrode manufacturer's directions.
Attach lead wires to electrodes first, prior to placing the electrodes on the patient.
Apply the electrodes to the patient in standard 5 lead configuration also mentioned below.
To minimize the motion artifact, make a small stress loop in each lead wire and tape the loop to the patient's skin.
Suggested lead placement
Lead preparation and placement should be carefully verified.
RA Place near right mid-clavicular line directly below the clavicle
LA Place near left mid-clavicular line directly below the clavicle
RL Place near 7th intercostal space in line with or lateral to the midpoint of right clavicle
LL Place near 7th intercostal space in line with or lateral to the midpoint of left clavicle
C Place in the intercostal space equivalent to V1, V2, V3, V4, V5 or V6
Monitoring Instructions
Avoid overlapping lead wires in their routing, don't coil or bundle them. Be sure lead wires are tightly secured and not let loose or hanging.
If the QRS complex is not twice the amplitude (height) of the P and T waves, a different monitoring lead should be selected for monitoring in the ECG 1 channel. Tall P and T waves may be incorrectly classified as a QRS complex, and/or may generate high heart rate or other alarm condition.
