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Unable to get a Good ECG

To ensure you are getting the best ECG quality, take the following steps:

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. 

 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 ECG electrodes contact. Use constant pressure to make sure the connection between the skin and the electrodes stays tight.

Avoid power sources

  • Proximity to nearby 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.
    • Patients with dry skin may be most in need of having additional solutions applied to their 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

Maintain close proximity of the DUO and the Eko app (within 5 feet) to ensure a good Bluetooth connection

Ensure that the ECG signal quality indicator is in the high quality (Green) zone 

  • The indicator will appear at the bottom of the screen if a DUO device is connected. You can always access these tooltips by clicking on the ECG signal quality indicator. 


LBL 231, Rev A, April 28, 2021

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