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Ensure the best audio and ECG quality with the DUO

The Eko DUO’s digital diaphragm only works when the device is turned on. There is no option to use it as an analog stethoscope. To achieve the highest quality auscultation when using the DUO, please follow the steps below:

How to ensure best audio quality

Minimize movement artifact

  • The DUO is sensitive to vibration and hand noise. 
  • Ask patient to not move or make any noise
  • Ensure patient is in a comfortable position
  • Place the DUO directly on the skin. (Remove clothing and neck jewelry, if possible).
  • Apply firm pressure. (Be careful not to turn the device off by pressing the center button.)

Minimize environmental noise

  • Seek a quiet area to conduct your analysis with the DUO to minimize artifacts
  • Ensure that no other objects are making contact with the Eko DUO

Choose the appropriate filter 


How to ensure best ECG signal quality

The ECG signal quality indicator will appear at the bottom of the screen when the DUO device is connected. See the recommendations below to optimize ECG quality. You can also access these tips by clicking on the ECG signal quality indicator. 

Use DUO directly on the skin

  • If both metal leads are not clearly in contact with the patient’s skin, then the device cannot capture an ECG. This may happen if the device is not flush against the patient’s skin. Sometimes a person’s chest is more contoured, which can make it difficult to lay the device flat on the patient. Best placement may vary, the DUO can be held in a variety of positions (vertically, horizontally, angled) across the patient’s anterior thoracic region in order to capture the best ECG signal. You may need to test a few different positions to get a good signal.

 Apply firm pressure

Exact location varies, see image below for details.

  • The DUO is sensitive to vibration and hand noise. Gripping and pressing the DUO tightly against the skin into position and keeping your hand as still as possible is essential to collecting clean signals.
  • Apply firm pressure against the chest to ensure good contact with the ECG electrodes. Use constant pressure to ensure the contact between the skin and the electrodes


Avoid power sources

  • Maintain distance from power sources (e.g. wall outlets). ECG leads (even typical 12 lead ECGs) are affected by electromagnetic fields generated by 50-60Hz power sources. Record data away from wall outlets and other power sources.

If the patient has thick chest hair, dry skin, or body fat and it is difficult to get a clean ECG signal, users may want to:

  • Shave the patient’s chest if hair is potentially obstructing the ECG signal
  • Apply water, saline, or ECG gel to the patient’s skin in order to improve conductivity and ECG signal. Eko recommends applying these solutions to the patient’s skin not directly on the DUO.
    • Eko suggests additional solutions especially for patients with dry skin.
    • Lotion is not an appropriate alternative to water, saline, or ECG gel. Properties in lotion may impede the signal.
    • Contact solution can also be used as an alternative to water, saline, or ECG gel.

Use ECG gel

When using the DUO, maintain close proximity to the Eko app (within 5 feet) to ensure a good Bluetooth connection. 


LBL 222, Rev A, April 28, 2021.

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