Glendale, CA (818) 557-6300 
We are starting to see notifications of ECG interpretation problems from our cardiology departments which have prompted the following reminders.
The leading causes of ECG complaints, with guidelines on how to prevent in italics, are listed below:
1. Omitted/incorrect STD (standardization) marks. – A normal 1.0mV (10mm high) STD mark is required to be included on the
mounted Lead I.
2. Incorrect mounting and/or length of lead strips required.– Use specifically designed for each ECG machine mounting boards.
3. Multiple artifacts and/or malfunctioning ECG machine. – If artifact occurs that cannot be cleared immediately, contact the
division manager; do not continue using equipment that is not operating properly.
4. Omission of the patient or applicant signature/date on the mounted Lead I or Lead II strip
– The patient must sign and date the Lead I or Lead II strip (dependent of ECG machine and its settings) for legal proof of completion for the correct patient
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RM Global Health
Examiners ECG Training Manual
Leads
The Standard ECG consists of 12 leads. The First three leads recorded are called the standard, or bipolar, leads (Lead I, Lead II, Lead III). The next three leads recorded are the augmented leads (AVR, AVL, AVF). The last six leads are the chest, or precordial, leads (V1, V2, V3, V4, V5, V6).
Applying the Electrodes and Wires
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Apply 10 electrodes as instructed below to obtain 12 lead Electrocardiogram.
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1st on right leg,
2nd- left leg.3rd– right wrist4th-left wrist V1 Fourth intercostals space at right margin of sternumV2 Fourth intercostals space at left margin of sternumV3 Midway between position 2 and position 4V4 Fifth intercostals space at junction of left midclavicular (or nipple) lineV5 At horizontal level of position 4 at left anterior axillary lineV6 At horizontal level of position 4 (and 5) at left midaxillary line
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Attach gray cable to machine and to appropriate electrodes (for example, LL – means left leg, RA- right arm, etc.)
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Attach black cord to ECG machine and plug it into suitable outlet..
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Turn the power switch ON (on rear of machine)
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Press button ON-OFF to apply power to the instrument. (Pressing it again will turn it off)
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Press AUTO button to operate machine in automatic mode.
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Do twice, after you done check ECG paper: all Leads are clear or not. If not- repeat again.
