12 LEAD EKG : ELECTRODE PLACEMENT

Objectives

The learner will verbalize indications to perform 12 lead EKG

The learner will Identify components of the 12 lead EKG machine, their function and data input process

The learner will understand correct placement of electrodes and connect EKG lead wires.

The learner will Identify good quality 12 lead EKG

Each learner will demonstrate correct placement of electrodes and connect EKG lead wires.

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PURPOSE OF EKG

EKG = electrocardiograph (also ECG)

Records and displays electrical activity of the heart between two points.

The direction in which the electric current flows toward the machine determines how the waveforms appear on

the EKG tracing.

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INDICATIONS FOR EKG

Evaluate for:

Ischemia, injury, or infarction

Rhythm or rate abnormalities

Electrolyte imbalances

Drug toxicity

Response to treatment

Baseline

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EQUIPMENT

EKG machine Display

Keyboard

Lead wires

Electrodes

Paper

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EKG MACHINE

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EKG KEYBOARD

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Lead Wires and Electrodes

Different Attachment Types, may clip or

button

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EKG lead wires

EKG electrodes

Performing the EKG

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Enter Patient Data

Last name

First name

ID number (Medical record #)

Age

Gender

Referred by (Name of prescriber)

Technician (Your name or initials)

Location (Each unit is designated a location #)

Be sure to identify patient as per NSLIJHS policy

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PATIENT INSTRUCTIONS & PREPARATION

Ask patient to undress while maintaining privacy

May wear gown open to front

Chest and limbs are exposed

Ask patient to lay flat and relax

Prepare skin for electrode placement (clean with skin prep if needed, and dry)

Place electrodes on the chest on skin between correct inter-costal spaces (use your index finger to locate)

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Underlying Structures

Heart Surfaces

Electrode Placement

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Electrode Placement

Six (6) Electrodes are attached to

Skin of chest wall.

Also called:

Precordial Leads:

V1 V6

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Electrode Placement

Four (4) Electrodes are attached to

Right Arm, Left Arm, Right Leg, Left Leg

RA, RL, LA, LL

2 Options

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PRECORDIAL (CHEST)

V1 = 4th ICS, at right sternum border

V2 = 4th ICS, at left sternum border

V3 = Equidistant between V2 & V4

V4 = 5th ICS, at mid-clavicular line

V5 = 5th ICS, at anterior axillary line

V6 = 5th ICS, at mid-axillary line

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Alternate Electrode Placement

By Special Order

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PEDIATRIC LEAD PLACEMENT

Standard 12-Lead electrode placement plus:

Electrode location

V3R =

Halfway between

V1 and V4R

V4R =

Mid-clavicular line in

Right 5th ICS

Video on 12 Lead EKG Placement

http://www.youtube.com/watch?v=GUIKXnot-1k

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EKG Waveform

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Normal 12 Lead ECG Good Quality

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EKG WITH WANDERING BASELINE

Poor Quality EKG Tracing

MUSCLE TREMORS

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EKG WITH PATIENT MOVEMENT

Poor Quality EKG Tracing

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TROUBLE SHOOTING

When no signal or a poor signal is observed, consider:

Have the cables been correctly connected?

Is the equipment functioning correctly?

Could external electrical equipment interference be a problem?

Was skin preparation adequate?

Could the electrodes suffer from gel dry out? or poor adhesion?

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EKG Lead Placement Activity

Instructions: Please click the link below and complete the

EKG Lead Placement activity by correctly positioning the electrodes on the chest and limbs.

http://www.m2hnursing.com/ecg_demo/12lead.php

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Thaler, M. (2012). The Only EKG Book Youll Ever Need (7th ed.). Philadeplphia, PA: Lippincott Williams & Wilkins.

Wagner, Galen S., Marriott's Practical Electrocardiography 11th Edition, Lippincott

Williams & Wilkins, Philadelphia, PA , 2008, Chapter Author: Wagner, Galen S.; Lim, Tobin

H. Chapter Title: Recording the Electrocardiogram.

Drew, et. Al, AHA Scientific Statement . Practice Standards for Electrocardiographic

Monitoring in Hospital Settings: An American Heart Association Scientific Statement From

the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease

in the Young: Endorsed by the International Society of Computerized Electrocardiology

and the American Association of Critical-Care Nurses . Circulation. 2004; 110: 2721-2746

References

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Post Test

It is required that you take an online post test after module completion.

Click on this Link to Access:

https://nslijhp.northshorelij.com/nursing/EWD/Pages/NursingQuizSystemSYS.aspx?user_facility=system&user_quiz=system-EKG-Lead

Passing score = 100%