Best Practices for 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 capture the best quality sound and electrical signals for your heart/lung assessment with the DUO, it is important for the device to maintain proper contact and placement on the body during the exam.

Skin preparation

If the patient has thick chest hair, dry skin, or is heavy, it may be difficult to get a good reading from the device. There are several sources of information on how to improve the electrocardiogram (ECG) signal by preparing the skin. Although Eko has not independently tested these preparatory steps, here is a summary of one reference:

  • Shave or cut any chest hair that is interfering with good electrode-skin contact.

  • Clean the skin thoroughly with soap and water, a non-alcohol wipe, or a 4x4 gauze pad.

  • Apply water, contact lens solution, or ECG gel to the skin. Do not use skin lotion.

  • If you have an ECG-specific skin prep pad, rub it on the skin to reduce electrical resistance.

Device placement

Both of the DUO’s metal ECG leads must be in full contact with the skin to capture a quality ECG signal. Best placement may vary, and the DUO can be held in a variety of positions (vertically, horizontally, angled) across the front of the patient’s chest in order to capture the best ECG signal.

The DUO is sensitive to vibration and hand noise. Try to maintain firm placement with minimal motion to ensure a clean ECG recording.

Be careful not to accidentally press the center button on the silver side of the DUO during your exam, as this will power the device off. “Palming” the DUO, as shown in the pictures below, allows you to apply firm and constant pressure against the chest while minimizing vibration and hand noise. It also minimizes the likelihood of accidentally pressing the DUO’s button and should help you keep both electrodes in good skin contact.



Troubleshooting if the heart and lung sounds can’t be heard clearly:

  • Make sure that no other objects are making contact with DUO.

  • Make sure you are not recording in environments prone to vibration.

  • Place the DUO directly on the skin, not over clothing.

For more detailed troubleshooting tips, see DUO Troubleshooting Guide.


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Date of Issue:

January 31, 2023

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