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12-Lead ECG Placement
12 EKG & ECG Placement Female Video
Why Is 12-Lead ECG Placement Important?
This is a big deal to mebecause I have on two occasions moved the someone else’s 12-lead ECG placementand identified a STEMI that was not visible with the original placement. On theflip side, recently I found a huge STEMI and when I got to the main hearthospital, the tech took my leads, moved them down, and couldn’t see the STEMI.
It’s terrible patientcare! These patients sit in the ED for hours while they wait for their lab workto come back. Only then do they realize they’re having a heart attack. A lot oftimes this could be avoided if the 12-lead was performed properly and the STEMIwas identified on the first go-around.
It takes literally lessthan 30 seconds to find the correct position for a 12-lead ECGplacement! By the way, did you know that if your electrodes are off by 2 centimeters that it can completely skew your EKG morphology?
How should we place 12-Lead ECG electrodes
Limb electrodes
l RA (right arm) - between the right shoulder and right wrist
l RL (right leg) - below the right torso and above the rightankle
l LA (left arm) - between the left shoulder and the left wrist
l LL (left leg) - below the left torso and above the left ankle
The positions of the upper limb electrodes can vary from wristto shoulder, but they should be uniformly distributed. For instance, if oneelectrode is attached to the right wrist, the other one should be on leftwrist, not shoulder. The same rule applies to the positions of the lower limbelectrodes.
Chest electrodes
l V1 - 4th intercostal space tothe right of the sternum
l V2 - 4th intercostal space tothe left of the sternum
l V3 - midway between V2 and V4
l V4 - 5th intercostal space atthe midclavicular line
l V5 - anterior axillary lineat the same horizontal level as V4
l V6 - midaxillary line at thesame horizontal level as V4 and V5
When placingelectrodes on female patients, electrodes V3- V6 should be placed under the breasts rather than on.Also, patient’s nipples shouldn’t be used as reference points for locating theelectrode position, because their locations vary from patient to patient. Up to50% of ECGs have V1 and V2 electrodes in a more superior location, which can causeT wave inversion; and up to 33 % have chest electrodes inferiorly or laterallymisplaced, which can alter the amplitudes.
12-lead ECG tips for special situations
12-Lead ECG ELECTRODE PLACEMENT FOR WOMEN
Asking a femalepatient to disrobe can be uncomfortable for the EMS provider, at first. Beprofessional. Explain to the patient what you plan to do in terms of electrodeplacement; emphasize that several of the chest leads may need to be placedaround and under the left breast.
Have a patient gownavailable for the patient to use after removing her clothing.
If the patient's leftbreast is large enough to cover the V3, V4, or V5 placement area, it will haveto be lifted up for proper electrode placement. If possible, you can ask thepatient to lift her own breast. Alternatively, use the back of yourstraightened hand to displace the breast.
12-Lead ECG ELECTRODE PLACEMENT FOR BARIATRIC PATIENTS
Obese patients mayappear to be more difficult at first to accurately place electrodes. The trickis to spend a few extra moments to locate the anatomic landmarks. Palpate moredeeply to feel the sternal border and Angle of Louie to place leads V1 and V2.V4 is usually located in a straight line below the nipple at the fifthintercostal space. Then, imagine a line track straight down the left lateralside of the chest. Along this line, at the mid-axillary line is the location oflead V6.
Once these leads areplaced, then V3 is placed halfway between V2 and V4. Finally, V5 is placedhalfway between V4 and V6.
12-Lead ECG ELECTRODE PLACEMENT FOR PREGNANT PATIENTS
Despite the appearance of the abdomen during advanced pregnancy, placement of the electrodes is the same. You can use the technique above if necessary.
Note that left-axisdeviation on the ECG may appear in both pregnant and obese patients. This isdue to the abnormal position of the heart as the diaphragm pushes high into thethoracic cavity.
ELECTRODE PLACEMENT FOR PEDIATRIC PATIENTS
Use smaller electrodesspecific to children. Adult electrodes will overlap and potentially causeinaccurate placement. For preschool age children and older, take time toexplain what you are doing. Young children will be fearful of the procedure,and may imagine that it will hurt, or that you will shock them. Having a parentclose by will help provide reassurance.
12-Lead ECG Placement important considerations
Locating the V1 /C1 position (fourth intercostal space) is critically important because it is the reference point for locating the placement of the remaining V/C leads. Tolocate the V1/C1 position:
1. Place your finger at the notch in the topof the sternum.
2. Move yourfinger slowly downward about 1.5 inches (3.8 centimetres) until you feel aslight horizontal ridge or elevation. This is the Angle of Louis where themanubrium joins the body of the sternum.
3. Locate thesecond intercostal space on the patient’s right side, lateral to and just belowthe Angle of Louis.
4. Move yourfinger down two more intercostal spaces to the fourth intercostal space, whichis the V1/C1 position.
5. Continuelocating other positions from V1. Other important considerations: · When placing electrodes on female patients, always place leadsV3-V6 and C3-C6 under the breast rather than on the breast. · Never use the nipples as reference points for locating theelectrodes for men or women patients, because nipple locations may vary widely
Related Posts
12-Lead ECG Placement
12 EKG & ECG Placement Female Video
Why Is 12-Lead ECG Placement Important?
This is a big deal to mebecause I have on two occasions moved the someone else’s 12-lead ECG placementand identified a STEMI that was not visible with the original placement. On theflip side, recently I found a huge STEMI and when I got to the main hearthospital, the tech took my leads, moved them down, and couldn’t see the STEMI.
It’s terrible patientcare! These patients sit in the ED for hours while they wait for their lab workto come back. Only then do they realize they’re having a heart attack. A lot oftimes this could be avoided if the 12-lead was performed properly and the STEMIwas identified on the first go-around.
It takes literally lessthan 30 seconds to find the correct position for a 12-lead ECGplacement! By the way, did you know that if your electrodes are off by 2 centimeters that it can completely skew your EKG morphology?
How should we place 12-Lead ECG electrodes
Limb electrodes
l RA (right arm) - between the right shoulder and right wrist
l RL (right leg) - below the right torso and above the rightankle
l LA (left arm) - between the left shoulder and the left wrist
l LL (left leg) - below the left torso and above the left ankle
The positions of the upper limb electrodes can vary from wristto shoulder, but they should be uniformly distributed. For instance, if oneelectrode is attached to the right wrist, the other one should be on leftwrist, not shoulder. The same rule applies to the positions of the lower limbelectrodes.
Chest electrodes
l V1 - 4th intercostal space tothe right of the sternum
l V2 - 4th intercostal space tothe left of the sternum
l V3 - midway between V2 and V4
l V4 - 5th intercostal space atthe midclavicular line
l V5 - anterior axillary lineat the same horizontal level as V4
l V6 - midaxillary line at thesame horizontal level as V4 and V5
When placingelectrodes on female patients, electrodes V3- V6 should be placed under the breasts rather than on.Also, patient’s nipples shouldn’t be used as reference points for locating theelectrode position, because their locations vary from patient to patient. Up to50% of ECGs have V1 and V2 electrodes in a more superior location, which can causeT wave inversion; and up to 33 % have chest electrodes inferiorly or laterallymisplaced, which can alter the amplitudes.
12-lead ECG tips for special situations
12-Lead ECG ELECTRODE PLACEMENT FOR WOMEN
Asking a femalepatient to disrobe can be uncomfortable for the EMS provider, at first. Beprofessional. Explain to the patient what you plan to do in terms of electrodeplacement; emphasize that several of the chest leads may need to be placedaround and under the left breast.
Have a patient gownavailable for the patient to use after removing her clothing.
If the patient's leftbreast is large enough to cover the V3, V4, or V5 placement area, it will haveto be lifted up for proper electrode placement. If possible, you can ask thepatient to lift her own breast. Alternatively, use the back of yourstraightened hand to displace the breast.
12-Lead ECG ELECTRODE PLACEMENT FOR BARIATRIC PATIENTS
Obese patients mayappear to be more difficult at first to accurately place electrodes. The trickis to spend a few extra moments to locate the anatomic landmarks. Palpate moredeeply to feel the sternal border and Angle of Louie to place leads V1 and V2.V4 is usually located in a straight line below the nipple at the fifthintercostal space. Then, imagine a line track straight down the left lateralside of the chest. Along this line, at the mid-axillary line is the location oflead V6.
Once these leads areplaced, then V3 is placed halfway between V2 and V4. Finally, V5 is placedhalfway between V4 and V6.
12-Lead ECG ELECTRODE PLACEMENT FOR PREGNANT PATIENTS
Despite the appearance of the abdomen during advanced pregnancy, placement of the electrodes is the same. You can use the technique above if necessary.
Note that left-axisdeviation on the ECG may appear in both pregnant and obese patients. This isdue to the abnormal position of the heart as the diaphragm pushes high into thethoracic cavity.
ELECTRODE PLACEMENT FOR PEDIATRIC PATIENTS
Use smaller electrodesspecific to children. Adult electrodes will overlap and potentially causeinaccurate placement. For preschool age children and older, take time toexplain what you are doing. Young children will be fearful of the procedure,and may imagine that it will hurt, or that you will shock them. Having a parentclose by will help provide reassurance.
12-Lead ECG Placement important considerations
Locating the V1 /C1 position (fourth intercostal space) is critically important because it is the reference point for locating the placement of the remaining V/C leads. Tolocate the V1/C1 position:
1. Place your finger at the notch in the topof the sternum.
2. Move yourfinger slowly downward about 1.5 inches (3.8 centimetres) until you feel aslight horizontal ridge or elevation. This is the Angle of Louis where themanubrium joins the body of the sternum.
3. Locate thesecond intercostal space on the patient’s right side, lateral to and just belowthe Angle of Louis.
4. Move yourfinger down two more intercostal spaces to the fourth intercostal space, whichis the V1/C1 position.
5. Continuelocating other positions from V1. Other important considerations: · When placing electrodes on female patients, always place leadsV3-V6 and C3-C6 under the breast rather than on the breast. · Never use the nipples as reference points for locating theelectrodes for men or women patients, because nipple locations may vary widely
Related Posts
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