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Patient Preparation
Proper preparation of the patient's skin is absolutely essential to obtaining a quality ECG recording.

Note: without good skin preparation, both noise and artifact will frequently degrade the patient’s ECG to the point
of being unusable by the physician

Materials Needed
a) For 3 channel recording, use five (5) Silver-Silver chloride disposable pre-jelled electrodes designed for
24 hour Holter monitoring. Do not use 12-lead ECG or Stress Test Electrodes. Use electrodes designed for
longer term 24 hour monitoring

b) 4 x 4 Prep Pads

c) Isopropyl Alcohol

Recommended Steps
a) Select the sites for electrode application. The electrodes must be applied over bone or cartilage. Refer to the Electrode Placement Charts (Figure_18)

b) Wipe the skin in the electrode areas with an alcohol prep pad

c) After allowing the skin to dry thoroughly, locate the electrode placement sites by palpation

d) Dry shave body hair from the electrode sites

e) Using a small square piece of an abrasive material (220 grit sandpaper or equivalent) and moderate pressure, abrade the skin at the electrode sites by making 3 or 4 crossing strokes. The strokes should cross at the chosen electrode site. Lightly brush the areas with a dry gauze pad to remove any debris

f) Connect the color coded snap-on lead wires to the appropriate electrodes before applying the electrodes to the patient

g) Once the backing is removed from each electrode, place it firmly on the prepared skin surface site. Tape leads onto electrodes

h) In order to prevent the lead from tugging directly on the electrodes, create a strain relief by looping each
lead wire and placing a strip of adhesive tape over the loop as well as on the electrode

Starting the Recording Process
For VX3 compact cards: Enter the patient’s personal data in the patient’s diary. Name, 9-digit patient ID no., start date, start time, etc.
a) Insert the Flash memory card into the recorder

b) The electrodes and lead wires should be attached to the patient as specified in the previous section (Electrode Attachment). Once this has been done, the lead wires must next be connected to the recorder. For the VX3, the circular connector plugs into the recorder and screws down

c) Install one fresh alkaline AA battery

Caution: all previous ECG patient data on the Memory card will be erased immediately once the new batteries
are inserted

For recorders, there are a number of setup options. To enter setup, hold down the ENTER key when putting in
the batteries.

Some of the options are as follows:

To set time and date, use the arrow keys to select Time or date and hit ENTER to select. Repeat for hours,
minutes and seconds. Use Save and Exit to set.

To set recording time select it, hit enter and select 24 or 48 hour recording. (the default is 24 hours)

To set "Pacer Detection" for this patient, enable it in the same manner as above. (this option is not stored and
must be activated as desired for each patient)

ECG's will stay on the screen for 10 - 15 minutes allowing the operator to ensure a good "hookup". Change electrodes as needed in order to have clean tall and positive "R" waves. Once a good "hookup" is verified,
record the start date and time in the patient's diary and dismiss the patient.

Examples of normal ECGs, noise, PVCs, etc. (Figure_13)