Electrocardiogram is the recording of the electrical activity of the heart. Traditionally this is in the form of a transthoracic interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached or displaced by a device external to the body. The recording produced by this non-invasive procedure is termed an ECG.
Indications for Pediatric ECG
| Clinical Scenario | Purpose |
|---|---|
| Chest pain, palpitations, syncope | Rule out arrhythmias or structural abnormalities |
| Congenital heart disease | Baseline and follow-up cardiac function |
| Family history of sudden cardiac death | Screen for inherited arrhythmias (e.g., Long QT syndrome) |
| Electrolyte imbalances | Detect conduction abnormalities |
| Preoperative assessment | Evaluate cardiac risk before anesthesia |
Placement of Electrocardiogram Leads in Paediatric Clients
In young children, the right ventricle normally extends to the right side of the sternum.
To appropriately display right ventricular potentials, ECGs for children in the under 5-year age-group must include an extra lead (V4R) on the right side of the chest at a point analogous to the left-sided V4.
Periodical Leads
- R4V: 5th intercostal space, right midclavicular line.
- V1: 4th intercostal space, right sternal border.
- V2: 4th intercostal space, left sternal border.
- V3: Use this lead for V4R, must label as much on ECG.
- V4: 5th intercostal space, right midclavicular
- V5: Anterior axillary line, same horizontal plane as V4
- V6: Midaxillary line, same horizontal line as V4
Limb leads: Place on the top part of arm or leg (less muscle interference)
Procedure
- Gather necessary supplies. Check the working conditions of leads and cables.
- Perform hand hygiene and wear gloves.
- Lay the child in supine position. Have the parents to be present at the bedside.
- Clean the area, that is, right and left side of the chest; left upper quadrant of the abdomen with soap and water.
- Remove the gloves and dispose it in kidney tray.
- Apply the gel to the areas where leads would be placed.
- Connect wires to the areas where leads would be placed.
- Connect wires to the electrode and then apply the electrode.
- Place the leads appropriately.
- Switch on the ECG machine and obtain reading.
- Remove the leads after the completion of all leads.
- Turn of the ECG machine.
Aftercare
- Wipe the area with cotton/tissue wipe.
- Praise the child for cooperation.
- Assist the child for wearing the dress.
- Record the procedure.
- Notify the pediatrician regarding significant findings.
Nurse’s Responsibilities in Monitoring Electrocardiogram Using Cardiac Monitor
- Check the monitor screen for correlating heart rate and respiratory rate.
- Adjust the monitor for complex sensitivities as necessary. Leads I, II, and III are most commonly used in children.
- Check the manufacture’s guidelines for operational instructions.
- Ensure that electrodes are correctly placed.
Change the electrodes as needed for infants and every 72 hours for older children.
- Assess the skin condition. Rotate the site when applying new electrodes.
- Notify the pediatrician when the heart and respiratory rates out of normal limits.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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