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Troubleshooting ECG artifact
Hearing up to 700 clinical alarms per patient day1 can be exhausting. Trying to interpret and troubleshoot ECG traces can be equally as tiring. 3M can help you identify the different sources of ECG artifact and help you troubleshoot poor trace quality.
Factors that can impact trace quality
- Skin impedance - The skin’s opposition or resistance to electrical signals flowing through it. This resistance of the skin, can impede the transmission of the electrical signal from the heart, to the sensing element in the electrode.
- Muscle movement - Patient movement can create artifact on an ECG trace, which can make it more difficult for the monitor to correctly identify alarms.
- Electrical continuity - Any break in the ECG signal path will stop the ECG signal from reaching the monitor. A cable or leadwire that isn't fully plugged in can also stop the ECG signal from reaching the monitor.
- Electrodes - Using fresh, high quality electrodes ensures good contact with the skin, providing reliable adhesion and conduction.
- Cabling - Broken cables or leadwires can prevent the ECG signal from reaching the monitor.
- Interference - Unwanted artifact on the ECG trace from nearby interfering sources such as power cords, infusion pumps, ventilators, etc. can easily be reduced by abrading the patient's skin.
- Equipment - Your monitor settings can have significant impact on the trace quality and alarm accuracy.
How to Troubleshoot ECG Artifacts
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Normal ECG Reading
This is what a normal ECG reading should look like when hooked up to a healthy patient. -
"Lead(s) Off" Error Message
- Electrical continuity: Check all electrode, leadwire and ECG cable connections.
- Equipment Check: verify number of leads is correctly set on the monitor.
- Electrodes: Check for electrode gel dry out.
- Skin impedance: Clean, then abrade the skin* prior to replacing the electrode.
- Cabling: Replace ECG cable and/or leadwires.
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Base Line Wander ECG Artifact
- Skin impedance: Abrade the skin* prior to replacing the electrode.
- Muscle movement: Move electrodes off of major muscle masses.
- Equipment: Adjust monitor filter settings to reduce artifact.
- Electrodes: Use the same ECG electrode on all sites.
- Electrical continuity: Check all electrode, leadwire and ECG cable connections.
- Cabling: Replace ECG cable and/or leadwires
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AC Noise (thick baseline) ECG Trace
- Skin impedance: Abrade the skin* prior to replacing the electrode.
- Interference: Move all power cords away from ECG cable and leadwires.
- Equipment: Adjust monitor filter settings to reduce artifact.
- Electrodes: Check for electrode gel dry out.
- Electrical continuity: Check all electrode, leadwire and ECG cable connections.
- Cabling: Replace ECG cable and/or leadwires.
- Muscle movement: May be untreatable involuntary muscle tremor.
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Intermittent Signal ECG Trace
- Electrical continuity: Check all electrode, leadwire and ECG cable connections.
- Skin impedance: Abrade the skin* prior to replacing the electrode.
- Electrodes: Check for electrode gel dry out.
- Interference: Remove possible static charge, touch metal (bedrail) prior to touching the patient.
- Cabling: Replace ECG cable and/or leadwires.
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Motion Artifact ECG Trace
- Muscle movement: Move electrodes off of large muscle masses.
- Skin impedance: Abrade the skin* prior to replacing the electrode.
- Electrical continuity: Check all electrode, leadwire and ECG cable connections.
- Equipment: Adust monitor filter settings to reduce artifact.
- Electrodes: Check for electrode gel dry out.
- Interference: Move ECG cable away from other equipment such as an infusion pump.
- Cabling: Replace ECG cable and/or leadwires.
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Low Amplitude ECG Trace
- Equipment: Adust monitor settings to increase ECG amplitude.
- Electrical continuity: Check all electrode, leadwire and ECG cable connections.
- Skin impedance: Abrade the skin* prior to replacing the electrode.
- Interference: Move ECG cable away from other equipment such as an infusion pump.
- Electrodes: Check for electrode gel dry out.
- Cabling: Replace ECG cable and/or leadwires.
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References
1. Cvach M, Monitor Alarm Fatigue: An Integrative Review, Biomedical Instrumentation & Technology, July/August 2012, pgs 268-277.
*Skin abrasion is not recommended for pediatric patients
