Several elements factor into quality electrocardiogram (ECG) readings, including proper electrode placement and effective skin preparation. The condition of the ECG machine and its clinical accessories also play an important role, as even a kinked leadwire can influence results.
Obvious mechanical components of an ECG machine are routinely inspected, replaced, and upgraded, however, materials managers and clinicians may not spare much thought for the ECG thermal paper that displays the electrical tracing of a patient's heart activity—yet the caliber of the paper used has the potential to impact readings.
How is this possible? What makes this particular component special? And why are hospitals and other healthcare settings still using physical paper to capture ECG readings?
Paper ECG Readings in the Digital Age
With so much of healthcare moving towards digitization and automation, it seems odd that the ECG—the first stop for analyzing and diagnosing cardiology concerns—is still relying on paper. The machine has seen significant improvements in both technology and design over the years, and yet the use of thermosensitive paper remains unchanging.
Learn more about the ECG: its history, its influence on modern medicine, and its future.
Today, most ECG machines do have the ability to digitally map electrical heart activity to an LCD screen. However, research has pointed to flaws in this approach. A study published in the Journal of the American College of Cardiology found that a lack of standardized algorithms across ECG machine manufacturers led to different computer-generated diagnoses.1 Specifically, computerized ECG interpretation of STEMI (ST-segment elevation myocardial infarction) generated false positive and false negative results in up to 42% of patients studied. What's more, interpreting ECG parameters can sometimes depend on the clinician's personal awareness of the patient's comorbidities and other symptom presentations that a computer cannot "see." This human element paired with a clinicians' nuanced knowledge of ECG interpretation resulted in the authors' recommendation that computerized ECG interpretation should only be used as an adjunct for clinical review—a supplement to the gold standard of printed, analog graphs.
The Power of Thermal Paper
Using regular paper in an ECG machine will not yield any results. This is because ECG machines, much like modern cash registers and credit card terminals, don't use ink cartridges. Instead, they rely on heat and thermosensitive paper.
Once an ECG's galvanometer detects a heart's electrical currents, it transmits them to a receiver, where the currents' strength and timing are measured, recorded, and sketched into a graph called a P wave. In order to create a tracing of this P wave in real-time, a heated stylus travels over paper with thermosensitive coating.
This specialized ECG thermal paper has several functional coatings and dyes that help:
- React when heat is applied to produce an image
- Smooth out the paper's imperfections and keep the dye from spreading once it's activated
- Protect the paper from light, dampness, and other environmental factors
It's important to employ high-quality ECG thermal paper, as uneven chemical coatings may lead to low-visibility tracings. Poor-quality paper may also limit clinicians' capacity for future consult and comparison since missing or uneven protective layers can cause image deterioration, shadows, and smudges. While all thermal paper will degrade over time, some recording papers are coated to resist fading and degradation for between 8 and 25 years.
Choosing Quality ECG Paper
While thermosensitive paper is not difficult to find, it's critical to purchase an option that will help clinical teams collect the best possible cardiac data. Not all thermal paper is made the same—weight, size, coatings, dyes, predicted longevity, and compatibility with ECG models/printers can all differ among available options.
GE Healthcare's diagnostic cardiology clinical accessories—including ECG thermal paper, cables, and leadwires—undergo strict testing to ensure quality, reliability, and safety as a complement to GE equipment such as the MAC VU360™ Resting ECG.2 It's important that ECG chart papers couple well with the machines they are paired with to avoid snags and jams; GE makes it easy to select thermal paper guaranteed to function effectively with GE ECG machines by consulting this compatibility chart.3
All of GE's archival-quality recording papers4 provide best-in-class functionality with a variety of features not seen on third-party options:
- Various sizes and formats to fit different printer configurations
- Optional on-chart BPM scale for different patient populations
- Large space for notes and patient information
- Low paper indicator
These features combine to form an ideal space for capturing a clear sketch of heart activity. As outdated as it may seem, paper is still the most effective way to capture these sketches. Therefore, employ top-quality ECG thermal paper in a top-quality ECG machine to ensure the best possible readings and provide clinicians with peace of mind that they are moving towards the best patient outcomes.
REFERENCES
- https://www.sciencedirect.com/science/article/pii/S0735109717387946
- https://www.gehealthcare.com/products/diagnostic-ecg/resting-ecg/mac-vu360
- https://www.gehealthcare.com/-/media/files/e/ecg_recording_paper_spec_sheet_sep_25_doc2146753_rev2.pdf
- https://www.gehealthcare.com/-/media/gehc/us/files/products/accessories/clinical-accessories/ecg-cables/lcs-clinical-accessories_spec-sheet_ecg-paper_global_doc2146753-rev-4.pdf?rev=-1
