HOSPITAL SHARED SERVICES

IPM Procedure for Electrocardiographs (Major)

Last Revised: March 28, 1991
Author: HOSPITAL SHARED SERVICES

Major:
Minor:

Interval
12 months

Time Required
0.8 Hours
Hours

DESCRIPTION
HSS PRODURE #:

B-1050

APPLICABLE TO:

Electrocardiographs [11-407]
Electrocardiographs, Multi-Channel [11-411]
Electrocardiographs, Single-Channel [11-413]

ALSO CALLED: EKG units, ECG units, EKG machines

COMMONLY USED IN: Electrocardiography departments, most patient care areas
SCOPE: Applies to single- and multi-channel electrocardiographs typically used for recording an
electrocardiogram on paper; may also be adapted for some systems that digitally store data and later
provide hard-copy tracings; not suitable for verifying performance of automated diagnostic
functions; does not apply to strip-chart recorders or direct writers, which should be inspected with
the ECG monitor or the defibrillator/monitor they are used in conjunction with (use the ECG
Monitors procedure and the Defibrillator/Monitors procedure, respectively)
SPECIAL PRECAUTIONS
Testing input isolation requires the use of a line voltage source. Although this source should include
a current-limiting resistor, use caution to avoid contact with any portions of the energized circuit.
TEST APPARATUS REQUIRED
G
G
G
G

Leakage Current Meter/Safety Analy

Ground Resistance Ohmmeter
ECG Simulator, Variable Output/Rate
Styluss Tension Gauge
SUPPLIES REQUIRED

G
G

Contact Cleaner
Lubricant Specified by Mfr

G Ruler, Metric, Transparent

Calipers,Drafting

IPM Procedure for Electrocardiographs (Major), Page 2

QUALITATIVE TASKS
CHASSIS/HOUSING: Examine the exterior of the unit for cleanliness and general physical
condition. Be sure that plastic housings are intact, that all assembly hardware is present and tight,
and that there are no signs of spilled liquids or other serious abuse.
MOUNT: If the device is mounted on a stand or a cart, examine the condition of the mount. If it is
attached to a wall or rests on a shelf, check the security of this attachment.
CASTERS/BRAKES: If the device moves on casters, check their condition. Look for accumulations
of lint and thread around the casters, and be sure that they turn and swivel, as appropriate. Check the
operation of brakes and swivel locks, if the unit is so equipped.
AC PLUG/RECEPTACLE: Examine the AC power plug for damage. Attempt to wiggle the blades
to determine that they are secure. Shake nonmolded plugs and listen for rattles that could indicate
loose screws. If any damage is suspected, open the plug and inspect it.
LINE CORD: Inspect the cord for signs of damage. If it is damaged, replace the entire cord or, if the
damage is near one end, cut out the defective portion. Be sure to wire a new power cord or plug
with the same polarity as the old one. Also check line cords of battery chargers.
STRAIN RELIEFS: Examine the strain reliefs at both ends of the line cord. Be sure that they hold
the cord securely.
CIRCUIT BREAKER/FUSE: If the device has a switch-type circuit breaker, check that it moves
freely. If the device is protected by an external fuse, check its value and type against that marked on
the chassis, and ensure that an appropriate spare is provided.
CABLES: Inspect the cables and leads and their strain reliefs for general condition. Examine cables
carefully to detect breaks in the insulation and to ensure that they are gripped securely in the
connectors of each end to prevent rotation or other strain.
Connect the unit to an ECG simulator, and verify that an adequate trace is received at each patient
lead selection. [Checking all leads in some units will require either a 12-lead simulator or
connection and disconnection of every lead.] Flex the patient cable near each end to verify that there
are no intermittent faults.
CONNECTORS: Examine all cable connectors for general condition. Electrical contact pins or
surfaces should be straight and clean. Leads and electrodes should be firmly gripped in their
appropriate connectors.
ELECTRODES: Confirm that an adequate supply of electrodes is on hand, and check the electrodes'
physical condition.

IPM Procedure for Electrocardiographs (Major), Page 3

CONTROLS/SWITCHES: Before moving any controls and alarm limits, check their positions. If
any settings appear inordinate (e.g., a gain control at maximum, alarm limits at the ends of their
range), consider the possibility of inappropriate clinical use or of incipient device failure. Record
the settings of those controls that should be returned to their original positions following the
inspection.
Examine all controls and switches for physical condition, secure mounting, and correct motion.
Check that control knobs have not slipped on their shafts. Where a control should operate against
fixed-limit stops, check for proper alignment, as well as positive stopping. Check membrane
switches for membrane damage (e.g., from fingernails, pens).
During the course of the inspection, check that each control and switch performs its proper
function.
BATTERY/CHARGER: Inspect the physical condition of batteries and battery connectors, if readily
accessible. Check operation of battery-operated power-loss alarms, if so equipped.
Perform the inspection with the unit on battery power or operate the unit on battery power for
several minutes to check that the batteries are charged and can hold a charge. Check battery capacity
by activating the battery-test function or measuring the output voltage. When it is necessary to
replace a battery, label it with the date.
Check the condition of the battery charger and, to the extent possible, confirm that it does, in fact,
charge the battery.
Some batteries require periodic deep discharges and recharging to maintain maximum battery
capacity. If this is recommended by the manufacturer, verify that it is being performed on schedule.
INDICATORS/DISPLAYS: During the course of the inspection, confirm the operation of all lights,
indicators, meters, and visual displays on the unit and the charger, if so equipped. Be sure that all
segments of a digital display function.
1 MV STEP RESPONSE: Depress and hold the 1 mV calibration button (or apply an external 1 mV
pulse) for about 3 sec. The trace should exhibit a sharp, square-cornered leading edge that is neither
rounded nor spiked. [Up to 10% spike or overshoot is acceptable but will usually not be observed in
a unit that is functioning optimally (see Figure 1 in the ECRI IPM manual).] After 2 sec (50 mm of
paper at a speed of 25 mm/sec), the pulse should have decayed no more than half its original
amplitude (see Figure 2 in the ECRI IPM manual).
LABELING: Check that all necessary placards, labels, and instruction cards are present and legible.
ACCESSORIES: Verify that an adequate supply of electrodes and paper and a fuse are stored with
the device or in the nursing unit for those electrocardiographs that remain in a fixed location. A
spare patient cable and stylus (or pen) may be kept with units on crash carts.

IPM Procedure for Electrocardiographs (Major), Page 4

TRACE QUALITY: Observe the tracing with the unit in the standard lead select position (no input)
and in lead I with a simulated ECG signal applied. Verify compliance with the following criteria:
G The baseline should have constant thickness; it should be horizontal and not drift vertically. It
should be possible to move the baseline from the lower to the upper border of the chart paper
with the the vertical position control, except on those units where mechanical stops prevent
such travel.
G The baseline should remain within 1 mm of its initial position upon pushing the reset control.
G If so equipped, the operator-adjustable stylus heat control should function and should not need
to be set near either extreme to obtain a satisfactory setting.
G All portions of a simulated ECG waveform should be clearly visible, including the P wave and
QRS.
G There should be no 60 Hz noise when the lead selector switch is set to the lead 0 or standard
position and the chart motor is activated.
PAPER TRANSPORT: Verify that the paper moves smoothly and without hesitation at all paper
speeds. Problems might be caused by the transport mechanism or by an excessively tightly wound
roll of paper. The paper should not drift sideways in the transport mechanism. If a formatted output
is used (i.e., unit prints a single formatted sheet for each electrocardiogram), verify that all
alphanumerics and tracings appear in the correct location and that the paper starts and stops at the
correct points.
PREVENTIVE MAINTENANCE
CLEAN EXTERIOR AND ACCESSORIES: Clean the exterior (including front panel controls), all
rollers, paper guides, and knife edges, as needed.
LUBRICATE RECORDER AND PAPER DRIVE: Lubricate the recorder mechanism and the paper
drive per the manufacturer's specifications.
CALIBRATE DAMPING AND STYLUS: Calibrate damping and stylus, as required. Use stylus
gauge to check tension.
QUANTITATIVE TASKS
GROUNDING RESISTANCE: Using an ohmmeter, electrical safety analyzer, or multimeter with
good resolution of fractional ohms, measure and record the resistance between the grounding pin of
the power cord and exposed (unpainted and not anodized) metal on the chassis.
CRITERION: #0.5
CHASSIS LEAKAGE CURRENT: Measure chassis leakage current to ground with the grounding
conductor of plug-connected equipment temporarily opened. Operate the device in all normal
modes, including on, standby, and off, and record the maximum leakage current.
CRITERION: #100 A

IPM Procedure for Electrocardiographs (Major), Page 5

CALIBRATION( GAIN ): This test determines the accuracy of the sensitivity control and of the
internal 1 mV calibration signal and requires the use of an external source of known amplitude (e.g.,
calibrated ECG simulator). If this calibration source is battery powered, check its output with a
precision voltmeter or similar instrument to confirm that the output is not affected by changing
battery voltage. An ECG simulator can be used, even if its output is not precisely 1 or 2 mV,
provided its amplitude is accurately known and appropriate corrections are made in interpreting the
results.
With sensitivity at 20 mm/mV, record a 1 mV pulse from the external reference generator and one
from the internal 1 mV calibration signal of the writer. For an externally generated pulse of exactly
1 mV, the tracing should be between 19 and 21 mm. Deviation greater than this can often be
corrected with the variable gain control (a screwdriver adjustment in many units). If the internally
generated pulse and a 1 mV external pulse produce tracings of heights that differ by more than 0.5
mm, the internal calibrator is not within the recommended 5% accuracy.
Next, record 1 mV pulses, either from the internal calibrator or the reference generator, at
sensitivity settings of 2.5, 5, 10, and 20 mm/mV.
At each setting, the trace should double in height (within 5%). Because of the difficulty in
resolving small errors, investigate any deviation of more than 0.5 mm.
CRITERION: 5% or 0.5 mm
LINEARITY: Apply a calibrated 2 mV input to the writer. Record the deflection at 10 mm/mV. It
should be twice the deflection (within 5%) observed for a 1 mV signal.
CRITERION: 5%
PAPER SPEED: Use an ECG simulator set to 60 bpm or a signal or pulse generator set to 1 Hz that
has been set or calibrated with a counter. If the interval between pulses is not within 10 msec at a
pulse interval of 1,000 msec, an appropriate correction should be made in calculating paper speed.
The speed should be accurate to within 2%. At a chart speed of 25 mm/sec and a pulse interval of
1,000 msec (60 bpm on an ECG simulator), the distance between the first and last of five successive
peaks should be 100 2 mm; at a chart speed of 50 mm/sec, the distance between the first and last of
five successive peaks should be 200 4 mm.
CRITERION: 2% = 0.5mm @ 25mm/sec @ 60BPM; R to R
GAIN VS BASELINE POSITION: Vary the centering or position control to change baseline
position. Using the internal calibration button, generate a pulse with the baseline set at the bottom
margin of the chart, another with the baseline at the middle of the chart, and a third with the baseline
as close to the top margin of the paper as possible while still allowing the pulse to remain on the
ruled chart. The height of the
calibration pulse should not vary more than 0.5 mm with baseline position.
CRITERION: Gain Variation, #0.5 mm
RETURN TO BASELINE POSITION: Check that trace returns to baseline after each cal pulse
CRITERION: Variation,#0.1 mm ;1/10th major division
DAMPING, HIGH FREQUENCY(1MV PULSE)
CRITERION: # 0.5mm Overshoot @ 2cm Pulse Height
INSTO BALLANCE(BETWEEN LEADS): Many units have adjustment so that trace is blanked
(signal is shorted) between leads. Check to verify that trace remains centered between leads.

IPM Procedure for Electrocardiographs (Major), Page 6

HOSPITAL SHARED SERVICES

IPM Form for Electrocardiographs (Major)(B-1050)
Work Order No.:

Location:

Control No:

Manufacturer:

Model:

Serial:

SPECIAL PRECAUTIONS
Testing input isolation requires the use of a line voltage source. Although this source should include
a current-limiting resistor, use caution to avoid contact with any portions of the energized circuit.
TEST APPARATUS REQUIRED
G
G
G

Leakage Current Meter/Safety Analy

Ground Resistance Ohmmeter
ECG Simulator, Variable Output/Rate

Styluss Tension Gauge

SUPPLIES REQUIRED
G
G

Contact Cleaner
Lubricant Specified by Mfr

G Ruler, Metric, Transparent

Calipers, Drafting

QUALITATIVE TASKS
G
G
G
G
G
G
G
G
G

Chassis/Housing
Mount
Casters/Brakes
AC Plug/Receptacle
Line Cord
Strain Reliefs
Circuit Breaker/Fuse
Cables
Connectors

G
G
G
G
G
G
G
G
G

Electrodes
Controls/Switches
Battery/Charger
Indicators/Displays
1 mV Step Response
Labeling
Accessories
Trace Quality
Paper Transport

PREVENTIVE MAINTENANCE
G
G

Clean Exterior and Accessories

Lubricate Recorder and Paper Drive

Calibrate Damping and Stylus

QUANTITATIVE TASKS
Task Description/Criterion

Set

Indicd

Measured

Pass

Fail

Pass

Fail

Grounding Resistance
#0.5
Chassis Leakage Current
#100 A
Work Order No.:

Control No.:

Task Description/Criterion

Set

Indicd

Measured

Calibration ( Gain )
5% or 0.5 mm
Linearity
5%
Paper Speed
2% = 0.5mm @ 25mm/sec @ 60BPM; R to R
Gain vs Baseline Position
Gain Variation, #0.5 mm
Return to Baseline Position
Variation,#0.1 mm ;1/10th major division
Damping, High Frequency(1mV pulse)
# 0.5mm Overshoot @ 2cm Pulse Height
Insto Ballance(between leads)
SUMMARY
G Service Required
Completed by:

G Removed from Use

Date

IPM Time

G Acceptable for Use

Repair Time