Considerations for ECG: Children, Pregnant Women, and the Elderly

Children

Special considerations when performing ECG on children.

Smaller Electrodes for Small Children

Specialist Paediatric Team: Smaller ECG electrodes may be needed for small children. Consider involving a specialist paediatric team for accurate ECG recording. Alternatively, limb leads using the arms and legs can provide a basic picture.

Landmarking on Larger-Bodied Children

Possible Placement: On larger-bodied children, it may be possible to place ECG electrodes without overlap. Aim for proper landmarking to ensure accurate placement, especially for children aged eight and above.

Pregnant Women

Considerations when performing ECG on pregnant women.

Challenges with ECG Placement

Impact of Pregnancy: As pregnancy progresses, the growing bump and larger breast tissue can make placing ECG electrodes under the breast tissue difficult. In such cases, document the change in placement position due to pregnancy.

The Elderly

Special considerations when performing ECG on elderly patients.

Fragile Skin and Adhesive Sensitivity

Delicate Skin: Elderly patients often have fragile skin prone to tears. Use sensitive electrodes if available. If not, advise the patient to thoroughly soak the area with soap and water before removing the electrodes to minimize disruption and potential skin tears.

Pacemaker Considerations

Factors to consider when a patient has a pacemaker.

Pacemaker Spikes on ECG

Normal Finding: Pacemakers may show pacing spikes on the ECG as straight lines, typically seen on every QRS complex. This indicates that the pacemaker is functioning correctly.

On-Demand Pacemakers

Varying Spiking Patterns: Some pacemakers are on-demand and will fire off at random intervals if the heart is not pacing itself. Regular pacing spikes may not be observed in these cases.

Pacemaker Battery Depletion

Irregular Rhythm: If the pacemaker battery is depleted, an irregular rhythm may be present on the ECG. Further intervention is required for patients with irregular pacing rhythms.