Level 1Cardiology Office Skills

Recognizing EKG Acquisition Problems

Spot artifact, lead reversal, and poor-quality tracings — and fix them before the provider reads it.

Beginner~11 min

Learning Objectives

1.Recognize common EKG artifacts and their causes.
2.Identify likely lead misplacement/reversal.
3.Correct issues and repeat when needed.

Goal

A messy or mis-wired EKG can mimic or hide real problems. Knowing how to spot and fix acquisition issues protects the patient and saves the provider time.

Common problems & causes

•Wandering baseline: movement, breathing, loose/dry electrodes.
•Muscle (shivering) artifact: cold, tense, or talking patient.
•Electrical (60-cycle) interference: nearby devices, cables touching.
•Lead reversal: limb leads swapped (e.g., arm leads) — looks "wrong."
•Flat or absent signal in a lead: poor electrode contact.

How to fix

1.Re-prep skin and replace poorly adhering electrodes.
2.Warm and reassure the patient; have them stay still and quiet.
3.Check that limb leads are on the correct limbs and not reversed.
4.Move/untangle cables away from electrical sources.
5.Repeat the tracing once corrected.

What NOT to do independently

•Don’t interpret rhythm; focus on quality. But do flag a tracing that looks abnormal so it’s read promptly.

Scope note

You ensure technical quality. If a tracing looks abnormal AND the patient is symptomatic, escalate immediately rather than just re-running it.

Red flags to report immediately

•A symptomatic patient (chest pain) with an abnormal-looking tracing — escalate now, don’t just repeat it.

Alert now

Quality issues get fixed; a symptomatic patient gets the nurse/provider immediately.

Documentation tips

•Note repeats and the reason (e.g., "repeated for artifact").

Checklist

Identified the artifact type and cause.
Re-prepped/repositioned and repeated.
Verified limb leads not reversed.
Escalated symptomatic + abnormal tracings.

Knowledge Check Quiz

Disclaimer: This content is for educational purposes only. It is not medical advice, does not replace clinical judgment, and is not a substitute for institutional protocols or certified medical interpreters. No patient health information (PHI) should be entered into this application.