I have an electrocardiogram (ECG) cart that will not give a 12-lead readout. What could be the problem?

ECG machines are monitoring devices; therefore, we should treat them like other monitors. Starting with the patient connection and working backward is easiest. Technicians need to understand that these devices are used heavily. They are connected and disconnected to patients many times a day. Therefore, it would be fair to assume that the problem is more likely to occur distal of the machine.

Starting at the patient connection, we find patches. Staff should be trained on how to attach patches, but several factors can determine whether the connection to the patient is good. First, was the skin prepared correctly? Most manufacturers state in their literature that the skin must clean and free of hair. Ensure that the patient has been shaved where the patch has been applied. In addition, check to make sure that the patch appears to have been applied recently, looking for debris, sweat, tape residue, etc. Next, you will want to ask staff if the patches are new. Most manufacturers recommend daily replacement of patches. The gel that is on the patch will dry in about 24 hours.

This also is a good time to observe if the ECG cart has patches laying around on it. I recommend to staff at my hospital that they use single-use patch packets. At one time, we used bulk packs of patches. This was a headache for biomed. The packs would lie around on carts for three to four days, and they would never work. Staff would always assume that the machine was broken. In reality, the patches were dried out and therefore could not conduct an electrical signal. After we switched to single-use packs, our work orders decreased dramatically.

Next, check whether the leads are connected securely. Several types of lead connectors are available, with the alligator clip and button being two of the most common. Both of these connectors have a small piece of metal inside that makes connection with the lead and the tab on the patch. This tiny piece of metal can break off or become corroded, rendering it incapable of conducting an electrical signal. Also, the connector itself can lose its ability to hold on to the patch. The clips typically can be replaced with ease, and replacing them often is good practice.

If an electrocardiogram (ECG) machine isn't giving a readout, start with the patient connection and work backward. Key questions include: Are the patches dried out? Are the leads securely connected? Do the leads have cracks or cuts? If the leads go to a module, is the connection okay?

If an electrocardiogram (ECG) machine isn't giving a readout, start with the patient connection and work backward. Key questions include: Are the patches dried out? Are the leads securely connected? Do the leads have cracks or cuts? If the leads go to a module, is the connection okay?

The next step is checking the leads themselves. Visually, do you see any cracks or cuts in them? When moving your hand along them, do you feel any cracks, cuts, or other damage to the cable?

After this step is complete, follow the lead back to the machine. Does it go directly to the machine or through some sort of module? Make sure all leads are connected securely. If the leads go to a module, check the lead connection at the module and ensure that the module is plugged into the machine. Here is a good tip: Make sure the module is plugged into the correct spot. I have had staff plug the module into the wrong “port.” We all know the unit will never function correctly when plugged into the wrong connection.

If you have completed the above steps and still have not found a problem, then you can begin troubleshooting the ECG machine. Most of the time, the problem will be fixed by the time you get to this point. If the unit is still not working correctly, start simple and follow your troubleshooting steps.

One other helpful tip: Sometimes, if the battery is not holding a good charge, staff will report the screen being fuzzy or cutting out. This usually is a good indication that the battery is either not fully charged or is not holding a good charge.

Author notes

Becky Crossley, CBET, is a BMET specialist in the Biomedical Engineering Department at the University of Pittsburgh Medical Center Susquehanna-Williamsport in Williamsport, PA. Email: crossleyrk@upmc.edu