Unless you’re performing a stress ECG test, ask the patient to lie still and quietly until the test is done.Ī slight ECG artifact is not uncommon.For patients that do not fit comfortably on the bed or exam table due to size, ask them to cross their arms on their stomach to reduce muscle tension and movement.With arms lying flat on the side, ask the patient to relax the shoulders and keep the legs uncrossed.If both positions are impossible, you can perform ECG with the patient in a more elevated position. Place patient in supine or Semi-Fowler’s position.These devices can produce artifact (interference) and cause problems with the readings. smartphone) are removed from the patient. Patient Positioning for 12-Lead ECG Placement The negative pole of all 6 leads is found at the center of the heart.

Like the augmented leads, the transverse leads are unipolar and requires only a positive electrode. RL doesn’t come up in ECG readings, and is considered as a grounding lead that helps minimize ECG artifact.īy using 6 chest electrodes, you get 6 transverse leads that provide information about the heart’s horizontal plane: V1, V2, V3, V4, V5, and V6. Keep in mind that RL is neutral (also known as point zero where the electrical current is measured). Hence it’s called the Einthoven’s triangle, named after Willem Einthoven who invented the first practical ECG. They also correspond with each other to form leads I (RA to LA), II (RA to LL) and III (LL to LA).Īs a result, they form an equilateral triangle. The principle behind Einthoven’s triangle describes how electrodes RA, LA and LL do not only record the electrical activity of the heart in relation to themselves through the aVR, aVL and aVF leads. The Einthoven’s triangle explains why there are 6 frontal leads when there are just 4 limb electrodes. On the other hand, the augmented leads-aVR, aVL, and aVF-are unipolar and requires only a positive electrode for monitoring.

Leads I, II, and III require a negative and positive electrode (bipolarity) for monitoring. In 12-lead ECG, there are 10 electrodes providing 12 perspectives of the heart’s activity using different angles through two electrical planes - vertical and horizontal planes.īy using 4 limb electrodes, you get 6 frontal leads that provide information about the heart’s vertical plane: Put simply, a lead is like a perspective.

Do not use nipples as reference points in placing electrodes for both men and women as nipple locations vary from one person to another.Ī lead is a glimpse of the electrical activity of the heart from a particular angle.

For female patients, place leads V3-V6 under the left breast.

For instance, do not attach an electrode on the right wrist and one on the left upper arm. However, there should be uniformity in your placement.

The limb leads can also be placed on the upper arms and thighs.

» LL (Left Leg) - Anywhere below the left torso and above the left ankleĪdditional notes on 12-lead ECG Placement: » LA(Left Arm) - Anywhere between the left shoulder and the left elbow » RL (Right Leg) - Anywhere below the right torso and above the right ankle » RA (Right Arm) - Anywhere between the right shoulder and right elbow Chest (Precordial) Electrodes and Placement In a 12-lead ECG, there are 12 leads calculated using 10 electrodes. To measure the heart’s electrical activity accurately, proper electrode placement is crucial. It helps EMS and hospital staff to quickly identify patients who have STEMI (ST elevation myocardial infarction or in other words, heart attack) and perform appropriate medical intervention based on initial readings. The main purpose of the 12-lead ECG is to screen patients for possible cardiac ischemia. These electrodes are connected to a machine that registers the heart’s electrical activity. These 12 views are collected by placing electrodes or small, sticky patches on the chest (precordial), wrists, and ankles. Think of it as 12 different points of view of an object woven together to create a cohesive story - the ECG interpretation. Today, the 12-Lead ECG remains a standard diagnostic tool among paramedics, EMTs, and hospital staff.Ī 12-lead ECG paints a complete picture of the heart’s electrical activity by recording information through 12 different perspectives. Since the first telecardiogram recorded in 1903, huge strides have been made in the recording and interpretation of ECG. When interpreted accurately, an ECG can detect and monitor a host of heart conditions - from arrhythmias to coronary heart disease to electrolyte imbalance. 12-Lead ECG Placement Guide with IllustrationsĪs a non-invasive yet most valuable diagnostic tool, the 12-lead ECG records the heart’s electrical activity as waveforms.

Pics of a cardiograph