About This Lesson
Now, some people think that the application of electrodes for 12 lead monitoring isn’t important. We are going to go over the steps to promote proper lead placement.
So, the first step is to bare the chest. That’s right, take whatever is covering the chest and get it off. This will ensure you don’t have cables snag on clothing or clothing rubbing off one of your electrodes during acquisition.
The next step is to prepare the chest area. In men, this may mean shaving and drying; in women, this may mean removal of the bra and placement of a hospital gown. I always try to grab a few gowns at the hospital for just this purpose. Provide privacy.
Now you are ready for electrode placement. Ensure your patient is lying down on there back known as supine. This will place the heart in it’s natural, neutral position without gravity pulling it out of position.
Lead V1 will go in the 4th intercostal space (the space between the 4th and 5th ribs) on the anterior chest to your left or the patient’s right. Similarly, lead V2 will go in the same place, just on your right or the patient’s left. You can locate the 4th intercostal space by palpating down the sternum starting from just under the collarbone. It is typically one or two spaces below the Angle of Luis.
This is where most new medics and students get confused. You place V4 BEFORE V3. Here’s why: V3 is supposed to go DIRECTLY between V4 and V2. With that said, where do we place V4?
It goes on the patient’s left midclavicular line in the 5th intercostal space. I remember this location by visualizing the intermammary line and palpate directly below it. This should be about the location of the 5th intercostal space. Now place V3 between V2 and V4.
Placing V5 and V6 are pretty easy as they are in line with V4. V5 is placed on the left anterior axillary line and V6 is placed on the left mid-axillary line.
Make sure that your leads are secured and that your limb leads are in the correct locations, and you are ready to acquire a 12 lead ECG.
