Difference between revisions of "STEMI-2017/C2/Introduction-to-Kallows-Device/English"

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<div style="margin-left:-0.035cm;margin-right:0cm;">Topic: KALLOWS - Positioning ECG leads, BP cuff and SpO2 probe</div>
+
<div style="margin-left:-0.035cm;margin-right:0cm;">Topic: KALLOWS - Positioning ECG leads, BP cuff and SpO2 probe  
  
<div style="margin-left:-0.035cm;margin-right:0cm;">Contributor Name: Jerry David, STEMI Team, Coimbatore</div>
+
<div style="margin-left:-0.035cm;margin-right:0cm;">Contributor Name: Jerry David, STEMI Team, Coimbatore  
  
<div style="margin-left:-0.035cm;margin-right:0cm;">Reviewed by: Nancy Varkey, Spoken Tutorial Project, IIT Bombay</div>
+
<div style="margin-left:-0.035cm;margin-right:0cm;">Reviewed by: Nancy Varkey, Spoken Tutorial Project, IIT Bombay  
  
 
Keywords: STEMI Kit, NIBP, SpO2, ECG, Electrode, B.P cuff, Mobmon 12.0
 
Keywords: STEMI Kit, NIBP, SpO2, ECG, Electrode, B.P cuff, Mobmon 12.0
Line 11: Line 11:
 
{| border=1
 
{| border=1
 
|-  
 
|-  
| '''''VISUAL CUE'''''
+
| '''''VISUAL CUE'''''
 
| '''''NARRATION'''''
 
| '''''NARRATION'''''
 
|-  
 
|-  
Line 21: Line 21:
 
|| Learning Objectives
 
|| Learning Objectives
 
|| In this tutorial we will learn to -  
 
|| In this tutorial we will learn to -  
# <div style="margin-left:1.27cm;margin-right:0cm;">Position '''ECG '''leads, '''B.P. '''cuff & '''SpO2'''</div>
+
# Position '''ECG '''leads, '''B.P. '''cuff & '''SpO2'''
# <div style="margin-left:1.27cm;margin-right:0cm;">Take an '''ECG''' and </div>
+
# Take an '''ECG''' and
# <div style="margin-left:1.27cm;margin-right:0cm;">Check Blood Pressure and '''SpO2'''</div>
+
# Check Blood Pressure and '''SpO2'''
 
+
  
 
|-  
 
|-  
Line 34: Line 33:
 
|| Show Image
 
|| Show Image
 
|| The '''STEMI Kit''' consists of  
 
|| The '''STEMI Kit''' consists of  
* <div style="margin-left:1.27cm;margin-right:0cm;">An '''Android Tab''' in a metal casing</div>
+
* An '''Android Tab''' in a metal casing  
* <div style="margin-left:1.27cm;margin-right:0cm;">'''Mobmon Device''' 12.0 </div>
+
* '''Mobmon Device''' 12.0
* <div style="margin-left:1.27cm;margin-right:0cm;">'''Bluetooth B.P. monitor'''</div>
+
* '''Bluetooth B.P. monitor'''  
* <div style="margin-left:1.27cm;margin-right:0cm;">'''ECG electrodes'''</div>
+
* '''ECG electrodes'''  
* <div style="margin-left:1.27cm;margin-right:0cm;">'''SPO2 probe'''</div>
+
* '''SpO2 probe'''  
* <div style="margin-left:1.27cm;margin-right:0cm;">'''Wi-Fi Printer'''</div>
+
* '''Wi-Fi Printer'''  
* <div style="margin-left:1.27cm;margin-right:0cm;">Power Strip</div>
+
* Power Strip  
 
+
  
 
|-  
 
|-  
Line 65: Line 63:
 
|| Show image
 
|| Show image
 
|| This '''probe''' is made up of the following parts-
 
|| This '''probe''' is made up of the following parts-
# <div style="margin-left:1.27cm;margin-right:0cm;">'''Oximetry probe/cable'''</div>
+
# '''Oximetry probe/cable'''  
# <div style="margin-left:1.27cm;margin-right:0cm;">'''Sensor'''</div>
+
# '''Sensor'''  
  
 
|-  
 
|-  
Line 83: Line 81:
 
|| Show image
 
|| Show image
 
|| While selecting a '''sensor''' site, priority should be given to an extremity free of -
 
|| While selecting a '''sensor''' site, priority should be given to an extremity free of -
# <div style="margin-left:1.27cm;margin-right:0cm;">an arterial catheter, </div>
+
# an '''arterial catheter''',
# <div style="margin-left:1.27cm;margin-right:0cm;">blood pressure cuff </div>
+
# '''blood pressure cuff''' 
# <div style="margin-left:1.27cm;margin-right:0cm;">or intravascular infusion line.</div>
+
# or '''intravascular infusion line'''.  
 
+
  
 
|-  
 
|-  
Line 92: Line 89:
  
 
|| The typical sites for '''oximetry probe '''connections are -
 
|| The typical sites for '''oximetry probe '''connections are -
* <div style="margin-left:1.27cm;margin-right:0cm;">For Adults/ Pediatrics: Finger, toe and pinna (top) or lobe of the ear.</div>
+
* For adults/ pediatrics: Finger, toe and pinna (top) or lobe of the ear.  
* <div style="margin-left:1.27cm;margin-right:0cm;">For Infants: Foot or Palm of the hand and the big toe or thumb.</div>
+
* For infants: Foot or palm of the hand and the big toe or thumb.  
 
+
  
 
|-  
 
|-  
||  
+
|| Show images as per narration
 
|| '''Pls note: '''
 
|| '''Pls note: '''
* <div style="margin-left:1.27cm;margin-right:0cm;">Reusable sensors may be used on the same site for a maximum period of 4 hrs, provided the site is inspected routinely to ensure skin integrity.</div>
+
* Reusable '''sensors''' may be used on the same site for a maximum period of 4 hrs, Make sure that the site is inspected routinely to ensure skin integrity.  
* <div style="margin-left:1.27cm;margin-right:0cm;">Do not use wet or damaged sensors. They may cause burns during the electro surgery or when applying other electrical device.</div>
+
* Do not use wet or damaged '''sensors'''. They may cause burns during the '''electro surgery''' or when applying other electrical device.  
* <div style="margin-left:1.27cm;margin-right:0cm;">Tissue damage/ burn can be caused by incorrect application or use of SpO2 sensor</div>
+
* Tissue damage/ burn can be caused by incorrect application or use of '''SpO2 sensor'''.
* <div style="margin-left:1.27cm;margin-right:0cm;">Do not twist unnecessarily or use excessive force when using, connecting, disconnecting or storing the sensor.</div>
+
* Do not twist unnecessarily or use excessive force when using, connecting, disconnecting or storing the '''sensor'''.  
* <div style="margin-left:1.27cm;margin-right:0cm;">Loss of pulse signal can occur if the sensor is too tight or if there is excessive illumination from light sources such as surgical lamp, a bilirubin amp or sunlight</div>
+
* Loss of '''pulse signal''' can occur  
 
+
**if the '''sensor''' is too tight or  
 +
**if there is excessive illumination from light sources such as surgical lamp, a '''bilirubin lamp''' or sunlight  
  
 
|-  
 
|-  
Line 115: Line 112:
 
|| Show image
 
|| Show image
 
||  
 
||  
# <div style="margin-left:1.27cm;margin-right:0cm;">Measure the patient's limb and select the proper '''cuff size'''. As a general rule, cuff width should span approximately two - thirds of the distance between patient, elbow, shoulder.</div>
+
# Measure the patient's limb and select the proper '''cuff size'''.  
# <div style="margin-left:1.27cm;margin-right:0cm;">Wrap the '''NIBP cuff''', preferably onto the left hand (on the brachial artery) of the patient as shown in the figure.</div>
+
# As a general rule, '''cuff''' width should span approximately two - thirds of the distance between patient, elbow, shoulder.
# <div style="margin-left:1.27cm;margin-right:0cm;">The''' NIBP cuff''' must be wrapped tightly on the patient's limb for proper management.</div>
+
# Wrap the '''NIBP cuff''', preferably onto the left hand (on the '''brachial artery''') of the patient as shown in the figure.  
 
+
# The''' NIBP cuff''' must be wrapped tightly on the patient's limb for proper management.  
  
 
|-  
 
|-  
 
||  
 
||  
 
|| Press the '''Start''' button to activate '''Bluetooth BP Monitor.'''
 
|| Press the '''Start''' button to activate '''Bluetooth BP Monitor.'''
 +
 
|-  
 
|-  
||  
+
|| Show the images as per narration
 
|| Pls note:  
 
|| Pls note:  
  
 
Inaccurate measurements may be caused by incorrect application or use such as-
 
Inaccurate measurements may be caused by incorrect application or use such as-
 
+
* Placing the '''cuff''' too loosely on the patient  
 
+
* Using incorrect '''cuff size'''  
* <div style="margin-left:1.27cm;margin-right:0cm;">Placing the '''cuff''' too loosely on the patient</div>
+
* Not placing the '''cuff''' at the same level of the heart  
* <div style="margin-left:1.27cm;margin-right:0cm;">Using incorrect '''cuff size'''</div>
+
* Leaky '''cuff''' or tube  
* <div style="margin-left:1.27cm;margin-right:0cm;">Not placing the '''cuff''' at the same level of the heart</div>
+
* Excessive patient motion.  
* <div style="margin-left:1.27cm;margin-right:0cm;">Leaky '''cuff''' or tube</div>
+
* <div style="margin-left:1.27cm;margin-right:0cm;">Excessive patient motion.</div>
+
 
+
  
 
|-  
 
|-  
||  
+
|| Show the images as per narration
 
|| Do not connect the '''SpO2 sensor '''and the '''B.P cuff '''to the same limb of the patient.
 
|| Do not connect the '''SpO2 sensor '''and the '''B.P cuff '''to the same limb of the patient.
 
  
 
This is to avoid nuisance alarms.
 
This is to avoid nuisance alarms.
Line 146: Line 140:
 
|| Show image
 
|| Show image
 
|| Make sure that while measuring the '''NIBP,''' the tube of the '''cuff''' is not blocked or tangled.
 
|| Make sure that while measuring the '''NIBP,''' the tube of the '''cuff''' is not blocked or tangled.
 
 
  
 
|-  
 
|-  
 
||  
 
||  
 
|| Finally, let’s see how to position the '''ECG leads.'''
 
|| Finally, let’s see how to position the '''ECG leads.'''
 +
 
|-  
 
|-  
 
|| '''PATIENT PREPARATION'''
 
|| '''PATIENT PREPARATION'''
|| Quality '''ECG''' rhythm can be obtained with good skin preparation and proper electrode placement.
+
|| Quality '''ECG''' rhythm can be obtained with good skin preparation and proper '''electrode''' placement.
 +
 
 
|-  
 
|-  
 
||  
 
||  
  
Follow the instructions given in the narration
+
Show images as per narration one by one
 
|| The following must be done for good patient preparation-
 
|| The following must be done for good patient preparation-
# <div style="margin-left:1.27cm;margin-right:0cm;">Clean '''electrode''' site and shave surface hair from chest</div>
+
# Clean '''electrode''' site and shave surface hair from chest  
# <div style="margin-left:1.27cm;margin-right:0cm;">Gently rub the skin with spirit to remove outer epidermal layer and skin becomes lightly red. </div>
+
# Gently rub the skin with spirit to remove outer epidermal layer and skin becomes lightly red.
# <div style="margin-left:1.27cm;margin-right:0cm;">Allow the '''electrode''' site to dry.</div>
+
# Allow the '''electrode''' site to dry.  
# <div style="margin-left:1.27cm;margin-right:0cm;">Remove dry '''gel''' from '''electrode''' surface, if any.</div>
+
# Remove dry '''gel''' from '''electrode''' surface, if any.  
# <div style="margin-left:1.27cm;margin-right:0cm;">Place the '''electrodes''' on the flat non-muscular & non-hairy areas</div>
+
# Place the '''electrodes''' on the flat non-muscular & non-hairy areas  
# <div style="margin-left:1.27cm;margin-right:0cm;">Use good quality (highly conductive) fresh '''gel'''. </div>
+
# Use good quality (highly conductive) fresh '''gel'''.
# <div style="margin-left:1.27cm;margin-right:0cm;">Apply sufficient quantity of gel on the '''electrode''' surface to establish good contact.</div>
+
# Apply sufficient quantity of gel on the '''electrode''' surface to establish good contact.  
 
+
  
 
|-  
 
|-  
 
|| Show image
 
|| Show image
 
|| Note:  
 
|| Note:  
# <div style="margin-left:1.27cm;margin-right:0cm;">Ensure that conductive portions of the </div>
+
Ensure that conductive portions of the
## <div style="margin-left:2.54cm;margin-right:0cm;">'''electrodes, leads '''and''' cables '''</div>
+
# '''electrodes, leads '''and''' cables ''' do not come into contact with any other conductive parts.
 
+
# Do not use damaged '''electrode leads'''.  
 
+
# Ensure that '''electrodes''' are not loosely applied.  
do not come into contact with any other conductive parts.
+
# This will cause artifacts and will sound heart rate alarms, causing endless inconvenience.  
# <div style="margin-left:1.27cm;margin-right:0cm;">Do not use damaged '''electrode leads'''.</div>
+
# <div style="margin-left:1.27cm;margin-right:0cm;">Ensure that '''electrodes''' are not loosely applied. This will cause artifacts and will sound heart rate alarms, causing endless inconvenience.</div>
+
 
+
  
 
|-  
 
|-  
 
|| Show image
 
|| Show image
 
|| This is how the '''electrodes''' should be placed.
 
|| This is how the '''electrodes''' should be placed.
 
 
  
 
{| style="border-spacing:0;width:8.334cm;"
 
{| style="border-spacing:0;width:8.334cm;"
Line 193: Line 181:
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
| align=center| RA
 
| align=center| RA
|| Right intraclavicular area
+
|| Right '''intraclavicular''' area
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
| align=center| LA
 
| align=center| LA
|| Left intraclavicular area
+
|| Left '''intraclavicular''' area
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
| align=center| V1
 
| align=center| V1
|| Fourth intercostal space at right border of sternum
+
|| Fourth '''intercostal''' space at right border of '''sternum'''
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
| align=center| V2
 
| align=center| V2
|| Fourth intercostal space at left border of sternum
+
|| Fourth '''intercostal''' space at left border of '''sternum'''
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
| align=center| V3
 
| align=center| V3
Line 208: Line 196:
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
| align=center| V4
 
| align=center| V4
|| Fifth intercostal space on left midclavicular line
+
|| Fifth '''intercostal''' space on left '''midclavicular line'''
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
| align=center| V5
 
| align=center| V5
|| Fifth intercostal left anterior axillary line
+
|| Fifth '''intercostal''' left '''anterior axillary line'''
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
| align=center| V6
 
| align=center| V6
|| Fifth intercostal left midaxillary line
+
|| Fifth '''intercostal''' left '''midaxillary line'''
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
| align=center| RL
 
| align=center| RL
|| Right lower abdominal quadrant just above inguinal ligament
+
|| Right lower '''abdominal quadrant''' just above '''inguinal ligament'''
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
|- style="border:1pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"
 
| align=center| LL
 
| align=center| LL
|| Left Lower abdominal quadrant just above inguinal ligament
+
|| Left lower '''abdominal quadrant''' just above '''inguinal ligament'''
 
|-
 
|-
 
|}
 
|}
  
 
|-  
 
|-  
| style="color:#ff0000;" |  
+
|| Show the image
 
|| Make sure the power cord and patient cable do not cross each other.
 
|| Make sure the power cord and patient cable do not cross each other.
 +
 
|-  
 
|-  
 
|| Show image
 
|| Show image
 
|| Switch on the '''Mobmon device''' by selecting power '''on/ off '''button on the side.
 
|| Switch on the '''Mobmon device''' by selecting power '''on/ off '''button on the side.
 +
 
|-  
 
|-  
 
|| STEMI App to be shown here
 
|| STEMI App to be shown here
 
|| Select '''ECG tab '''on the '''STEMI device '''to view the '''ECG''', in the '''ECG''' live steam page.
 
|| Select '''ECG tab '''on the '''STEMI device '''to view the '''ECG''', in the '''ECG''' live steam page.
 +
 
|-  
 
|-  
||  
+
|| Summary slide
||
+
|-
+
||
+
|| Let us summarize.
+
|-
+
 
|| Let us summarize.
 
|| Let us summarize.
|| In this tutorial, we have learnt -
 
* <div style="margin-left:1.27cm;margin-right:0cm;">how to position '''ECG leads, BP cuff '''and''' SpO2 probe.'''</div>
 
* <div style="margin-left:1.27cm;margin-right:0cm;">Take an''' ECG'''</div>
 
* <div style="margin-left:1.27cm;margin-right:0cm;">Check '''blood pressure '''and''' SPO2'''</div>
 
  
 +
In this tutorial, we have learnt -
 +
* how to position '''ECG leads, BP cuff '''and''' SpO2 probe.'''
 +
* Take an''' ECG'''
 +
* Check '''blood pressure '''and''' SPO2'''
  
 
|-
 
|-
 
|| Show STEMI INDIA slide
 
|| Show STEMI INDIA slide
 
|| '''STEMI INDIA'''
 
|| '''STEMI INDIA'''
* <div style="margin-left:1.058cm;margin-right:0cm;">was set up as a ‘not for profit’ organisation</div>
+
* was set up as a ‘not for profit’ organisation  
* <div style="margin-left:1.058cm;margin-right:0cm;">primarily to reduce delays in accessing appropriate care for heart attack patients</div>
+
* primarily to reduce delays in accessing appropriate care for heart attack patients  
* <div style="margin-left:1.058cm;margin-right:0cm;">and reducing deaths due to heart attacks</div>
+
* and reducing deaths due to heart attacks  
 
+
  
 
|-
 
|-
 
|| Show Spoken Tutorial Project Slide
 
|| Show Spoken Tutorial Project Slide
|| Spoken Tutorial Project, IIT Bombay <span style="background-color:#ffffff;">is funded by NMEICT, MHRD, Govt. of India.</span>
+
|| Spoken Tutorial Project, IIT Bombay is funded by NMEICT, MHRD, Govt. of India.
  
  
For more details, please visit http://spoken-tutorial.org
+
For more details, please visit https://spoken-tutorial.org
 
|-
 
|-
 
|| Show THANK YOU slide
 
|| Show THANK YOU slide
 
|| This tutorial has been contributed by
 
|| This tutorial has been contributed by
* <div style="margin-left:1.058cm;margin-right:0cm;">STEMI INDIA</div>
+
* STEMI INDIA  
* <div style="margin-left:1.058cm;margin-right:0cm;">and the Spoken Tutorial Project, IIT Bombay.</div>
+
* and the Spoken Tutorial Project, IIT Bombay.  
  
 
This is Nancy Varkey signing off. Thanks for joining.
 
This is Nancy Varkey signing off. Thanks for joining.
 
|-
 
|-
 
|}
 
|}

Latest revision as of 22:14, 1 July 2020

Topic: KALLOWS - Positioning ECG leads, BP cuff and SpO2 probe
Contributor Name: Jerry David, STEMI Team, Coimbatore
Reviewed by: Nancy Varkey, Spoken Tutorial Project, IIT Bombay

Keywords: STEMI Kit, NIBP, SpO2, ECG, Electrode, B.P cuff, Mobmon 12.0


VISUAL CUE NARRATION
Show Slide

Kallows STEMI Kit.

Hello and welcome to this tutorial on the Kallows STEMI Kit.
Learning Objectives In this tutorial we will learn to -
  1. Position ECG leads, B.P. cuff & SpO2
  2. Take an ECG and
  3. Check Blood Pressure and SpO2
Show Slide

Hardware Requirements

To practise this tutorial, you will need the Kallows STEMI Kit.
Show Image The STEMI Kit consists of
  • An Android Tab in a metal casing
  • Mobmon Device 12.0
  • Bluetooth B.P. monitor
  • ECG electrodes
  • SpO2 probe
  • Wi-Fi Printer
  • Power Strip
Show image This is the Mobmon device.
Show image It has a power button along with the charging port on the left side.
Show image And the SpO2 and ECG ports on the back side.
Show image This cable head has to be inserted into the ECG port on the Mobmon device.
Show image After connecting, secure the connection with the screws provided on either sides.
Show image Next, we will learn about the SpO2 probe.
Show image This probe is made up of the following parts-
  1. Oximetry probe/cable
  2. Sensor
Show image Let’s now see how to position the SpO2 probe.
Show image Connect the oximetry probe/cable to the SpO2 connector on the Mobmon device.
Show image This is how it should look when connected.
Show image The patient's finger must be inserted right to the end of the sensor as shown in the figure.
Show image While selecting a sensor site, priority should be given to an extremity free of -
  1. an arterial catheter,
  2. blood pressure cuff
  3. or intravascular infusion line.
Show image The typical sites for oximetry probe connections are -
  • For adults/ pediatrics: Finger, toe and pinna (top) or lobe of the ear.
  • For infants: Foot or palm of the hand and the big toe or thumb.
Show images as per narration Pls note:
  • Reusable sensors may be used on the same site for a maximum period of 4 hrs, Make sure that the site is inspected routinely to ensure skin integrity.
  • Do not use wet or damaged sensors. They may cause burns during the electro surgery or when applying other electrical device.
  • Tissue damage/ burn can be caused by incorrect application or use of SpO2 sensor.
  • Do not twist unnecessarily or use excessive force when using, connecting, disconnecting or storing the sensor.
  • Loss of pulse signal can occur
    • if the sensor is too tight or
    • if there is excessive illumination from light sources such as surgical lamp, a bilirubin lamp or sunlight
NIBP CUFF PLACEMENT Next, let’s learn how to position Blood Pressure cuff.
Show image Connect the cuff connector to NIBP Connector of the Bluetooth device.
Show image
  1. Measure the patient's limb and select the proper cuff size.
  2. As a general rule, cuff width should span approximately two - thirds of the distance between patient, elbow, shoulder.
  3. Wrap the NIBP cuff, preferably onto the left hand (on the brachial artery) of the patient as shown in the figure.
  4. The NIBP cuff must be wrapped tightly on the patient's limb for proper management.
Press the Start button to activate Bluetooth BP Monitor.
Show the images as per narration Pls note:

Inaccurate measurements may be caused by incorrect application or use such as-

  • Placing the cuff too loosely on the patient
  • Using incorrect cuff size
  • Not placing the cuff at the same level of the heart
  • Leaky cuff or tube
  • Excessive patient motion.
Show the images as per narration Do not connect the SpO2 sensor and the B.P cuff to the same limb of the patient.

This is to avoid nuisance alarms.

Show image Make sure that while measuring the NIBP, the tube of the cuff is not blocked or tangled.
Finally, let’s see how to position the ECG leads.
PATIENT PREPARATION Quality ECG rhythm can be obtained with good skin preparation and proper electrode placement.

Show images as per narration one by one

The following must be done for good patient preparation-
  1. Clean electrode site and shave surface hair from chest
  2. Gently rub the skin with spirit to remove outer epidermal layer and skin becomes lightly red.
  3. Allow the electrode site to dry.
  4. Remove dry gel from electrode surface, if any.
  5. Place the electrodes on the flat non-muscular & non-hairy areas
  6. Use good quality (highly conductive) fresh gel.
  7. Apply sufficient quantity of gel on the electrode surface to establish good contact.
Show image Note:

Ensure that conductive portions of the

  1. electrodes, leads and cables do not come into contact with any other conductive parts.
  2. Do not use damaged electrode leads.
  3. Ensure that electrodes are not loosely applied.
  4. This will cause artifacts and will sound heart rate alarms, causing endless inconvenience.
Show image This is how the electrodes should be placed.
Electrode Placement
RA Right intraclavicular area
LA Left intraclavicular area
V1 Fourth intercostal space at right border of sternum
V2 Fourth intercostal space at left border of sternum
V3 Fifth rib between V2 & V4
V4 Fifth intercostal space on left midclavicular line
V5 Fifth intercostal left anterior axillary line
V6 Fifth intercostal left midaxillary line
RL Right lower abdominal quadrant just above inguinal ligament
LL Left lower abdominal quadrant just above inguinal ligament
Show the image Make sure the power cord and patient cable do not cross each other.
Show image Switch on the Mobmon device by selecting power on/ off button on the side.
STEMI App to be shown here Select ECG tab on the STEMI device to view the ECG, in the ECG live steam page.
Summary slide Let us summarize.

In this tutorial, we have learnt -

  • how to position ECG leads, BP cuff and SpO2 probe.
  • Take an ECG
  • Check blood pressure and SPO2
Show STEMI INDIA slide STEMI INDIA
  • was set up as a ‘not for profit’ organisation
  • primarily to reduce delays in accessing appropriate care for heart attack patients
  • and reducing deaths due to heart attacks
Show Spoken Tutorial Project Slide Spoken Tutorial Project, IIT Bombay is funded by NMEICT, MHRD, Govt. of India.


For more details, please visit https://spoken-tutorial.org

Show THANK YOU slide This tutorial has been contributed by
  • STEMI INDIA
  • and the Spoken Tutorial Project, IIT Bombay.

This is Nancy Varkey signing off. Thanks for joining.

Contributors and Content Editors

Nancyvarkey, PoojaMoolya