NHA EKG Technician common mistakes
NHA EKG Technician · Understand the traps and how to avoid them.
Starts the 12-lead without confirming the patient's name and date of birth against two identifiers and without asking about adhesive or latex allergies.
Candidates memorize lead order and rush to place electrodes, treating patient identification as a formality.
What to do instead
Verify two identifiers, ask about allergies and skin conditions, and document before exposing the chest.
Applies electrodes directly over lotion, sweat, or chest hair without cleansing, drying, or clipping.
Time pressure and the belief that electrode gel will cut through interference.
What to do instead
Rub the skin with gauze or an alcohol pad, dry it, clip hair if needed, and reapply electrodes if baseline wander appears.
Moves from patient to patient without hand hygiene or disinfecting reusable cables and lead wires.
Focus is on the machine and tracing; equipment is not recognized as a fomite.
What to do instead
Perform hand hygiene before and after contact and disinfect cables per manufacturer instructions between patients.
Places limb or precordial leads by memorized color sequence alone, resulting in swapped RA/LA or V1/V2 in the wrong intercostal space.
Color codes vary and candidates do not landmark from anatomy.
What to do instead
Landmark from the sternal notch, count intercostal spaces, and confirm RA/LA placement before recording.
Records a tracing without checking that the machine is set to 25 mm/s and 10 mm/mV and that the calibration pulse is present.
Assumes default settings are intact, but a previous user may have changed them.
What to do instead
Verify paper speed, gain, and calibration pulse at the start of every recording and note any changes in documentation.
Labels somatic tremor, baseline wander, or 60-cycle interference as atrial fibrillation or another dysrhythmia.
Pattern recognition is applied without first assessing tracing quality.
What to do instead
Inspect for artifact first: check electrode adhesion, patient shivering, and nearby electrical equipment; correct the cause and re-record before interpreting.
Uses the 1500 small-box method to calculate heart rate on an irregular rhythm.
Only one formula is memorized and irregularity is ignored.
What to do instead
Use the 6-second strip count times 10 for irregular rhythms; use R-R averaging only when the rhythm is regular.
Fails to recognize pacemaker spikes or mislabels a paced beat as a native bundle branch block.
Spikes are small and candidates do not scan for them before analyzing QRS morphology.
What to do instead
Scan the full tracing for vertical spikes before each P wave or QRS and correlate each spike with capture.
Sees a wide-complex tachycardia, ST elevation, or another critical finding on the tracing and files it without immediately notifying the provider.
Uncertainty about scope of practice or fear of being wrong delays escalation.
What to do instead
Follow the critical-value policy: report immediately, document the time and recipient, and stay with an unstable patient.
Cannot map ECG waveform components to the conduction pathway, such as calling the PR segment the P wave or confusing the QT interval with the QRS.
Memorizes waveform shapes without linking them to SA node, AV node, and His-Purkinje activation.
What to do instead
Draw the conduction pathway and label each ECG component by its electrical event; practice on a normal tracing until the sequence is automatic.