Minimizing ECG artifact

ECG artifact nearly always originates from sources unrelated to the monitor. The
following are best practice suggestions for minimizing artifact.

Identifying the culprit electrode

ƒƒ If the artifact is in leads I and II but not III, the RA electrode is the source
ƒƒ If the artifact is in I and III but not II, the LA electrode is the source
ƒƒ If the artifact is in II and III but not I, the LL electrode is the source
ƒƒ If the artifact is unique to one V lead, its V electrode is the source

Minimizing motion artifact

Mild skin abrasion with fine sandpaper or gritty gel effectively minimizes all types of
motion and electrostatic artifact (medical products are available for this)

Respiration: Low frequency (0.4–2 Hz)

ƒƒ Check for dried gel
ƒƒ Abrade skin
ƒƒ Have patient take deep
breath, let half out and
hold while acquiring
the ECG

Patient movement: Low frequency (1–3 Hz)

ƒƒ Check for dried gel
ƒƒ Abrade skin
ƒƒ Have patient lie still
and stop talking

Transport: Medium frequency (3–15 Hz)

ƒƒ Check for dried gel
ƒƒ Abrade skin
ƒƒ Stop ambulance to get
clean ECG

Minimizing muscle artifact

Skin prep will not help, but other techniques can help

Muscle tension: High frequency (20-150 Hz)

ƒƒ Assure that limbs are supported and the
patient is lying flat
ƒƒ Ask the patient to relax
ƒƒ Consider pain Rx if pain is the likely cause

ƒƒ Reducing the upper cutoff frequency filter

from 150 to 40 Hz reduces muscle artifact

Muscle tremor: High frequency (20-150 Hz) and/or medium frequency (3-5 Hz)
ƒƒ If shivering, cover with a blanket
ƒƒ Move limb electrode elsewhere on
limb to avoid culprit muscle
ƒƒ Abrade skin if there is motion artifact

Intermittent or missing leads

Intermittent lead

ƒƒ Check for dry electrodes

ƒƒ Shave or clip hair from electrode site if excessive hair is present
ƒƒ Alcohol wipe if skin is oily or sweaty
ƒƒ Check for intermittent cable failure by trying a different cable
ƒƒ For intermittent connector on ECG device, service call needed

Missing lead

ƒƒ Check for dry electrodes

ƒƒ Verify that electrode and lead wire are attached to patient
ƒƒ Replace worn or broken lead wire or patient cable
ƒƒ For worn or broken connector on ECG device, service call needed
Minimizing electromagnetic interference (EMI)
Power line: High frequency (16.7, 50, 60, 100, 120, 150, 180 Hz)

ƒƒ Identify likely source, turn off or increase distance

ƒƒ Inverse square law: increasing the distance to the
EMI source by 10x decreases the artifact to 1/100th
ƒƒ If it happens often, verify that ECG device is set to
correct line frequency filter (50 or 60 Hz)
ƒƒ Skin abrasion and wet gel sometimes solve it

Cell phone or other equipment: High frequency

ƒƒ Identify likely source, turn off or increase distance

Implanted pacemakers and stimulators

Paced rhythm: High frequency spikes (>100 Hz)
ƒƒ Change upper cutoff frequency to
150 Hz if you want to increase the
visibility of pacemaker spikes

Gastric or other stimulator: High frequency spikes (>40 Hz)

ƒƒ Look for a lead with low
stimulator artifact
ƒƒ Record a 12-lead ECG and select a
lead with low stimulator artifact
ƒƒ Some devices can be temporarily
turned off with a magnet

ƒƒ Other stimulators include occipital nerve stimulators, deep brain stimulators,

sacral nerve stimulators and carotid stimulators

Skin preparation techniques

ƒƒ Choose an ECG electrode site away from areas with a large amount of adipose
tissue, major muscle groups or bony prominences

ƒƒ Excessive hair should be clipped or shaved

yy Hair can prevent ECG electrode adhesion to the skin

ƒƒ Mild skin abrasion with fine sandpaper or gritty gel (medical products are
available for this purpose)
yy Swipe an X with sandpaper to scratch the skin and place the electrode gel
on the center of the X
yy Skin abrasion minimizes motion artifact, but not muscle artifact

ƒƒ Dry towel or gauze pad skin rub

yy Useful for patients with sweaty or oily skin to improve electrode adhesion
yy Does not reduce motion or muscle artifact

ƒƒ Isopropyl alcohol wipe

yy This can help the electrodes stick to the skin, but it does not reduce motion
or muscle artifact

Types of ECG artifact Cause

Motion artifact Occurs when the skin is stretched, resulting
in a change to the skin voltage at the stratum
lucidum, the second layer down in the skin
Muscle artifact Generated by skeletal muscles
Electrostatic artifact When an electrostatically charged person
moves near the patient or ECG device, currents
flow through the high resistance of the stratum
corneum (top skin layer) and generate a voltage
Poor contact artifact Caused by dried gel, excessive hair, poor
adhesion or when breaks in connectivity
occur anywhere between the electrode and
the monitor
Electromagnetic Interference Generated by items like power lines, cell
(EMI) phones or radios; relatively uncommon
Implanted stimulators Artifact is greatest in leads parallel to the
stimulus lead; pacemakers are common but
other stimulators are rare

Physio-Control, Inc. | [Link] | GDR 3306627_B | Copyright © 2019 Stryker