ECG lead placement in the perioperative period: A quality improvement project

Abstract

Continuous monitoring of heart rate and rhythm via ECG is a staple of perioperative care. It allows timely response to changes that require intervention and allows the anesthesia provider to make proper decisions about care. Accuracy of the ECG is dependent on correct placement of the leads, however researchers have shown that ECG leads are frequently misplaced. Improper ECG lead placement may not reveal true cardiac changes and may emulate untrue changes simply due to lead malposition. The aim of this Doctor of Nursing Practice Quality Improvement (QI) project was to assess anesthesia providers’ perceived confidence in placing ECG electrodes in the three most common surgical positions (supine, lateral, and prone), before and after using an ECG lead placement education tool in their practice for a two-week period. This project was conducted at a large, level 1 trauma center located in the southeastern United States. A single plan, do, study, act cycle was completed using a pre- and post-survey design incorporating Qualtrics and Excel for data collection and analysis. The project involved 10 CRNAs who participated voluntarily. Results demonstrated an increase in perceived confidence in placing ECG electrodes after using the educational tools, and revealed additional considerations that may be beneficial to include in future iterations.