12 lead EKG question

[celticcare]

I'm a coronary Care Unit nurse and all the points above are the rationale for why I lay my patient back for acquisition of a 12 lead. Standing up adipose tissue *hey I'm being polite not to say large amounts of fat lol* droops downwards so it can give misplacements of the leads. Laying flat/flatish, allows the excess to droop to the side allowing adequate placement of the leads in the positions around the heart.

Question though, and I do both techniques dependent on situation.... when you are placing the limb leads, do many people place them on the torso also? Or go for the wrists or ankles. I do both as I said dependent on situation (if my patient is attached to the 12 lead consantly in their initial arrival to the unit, I will use the torso, for intermittant 12 leads and once a day acquisitions, I will use the limbs.)

Scotty

[firedoc5]

I'm a coronary Care Unit nurse and all the points above are the rationale for why I lay my patient back for acquisition of a 12 lead. Standing up adipose tissue *hey I'm being polite not to say large amounts of fat lol* droops downwards so it can give misplacements of the leads. Laying flat/flatish, allows the excess to droop to the side allowing adequate placement of the leads in the positions around the heart.

Question though, and I do both techniques dependent on situation.... when you are placing the limb leads, do many people place them on the torso also? Or go for the wrists or ankles. I do both as I said dependent on situation (if my patient is attached to the 12 lead consantly in their initial arrival to the unit, I will use the torso, for intermittant 12 leads and once a day acquisitions, I will use the limbs.)

Scotty

Before we started doing 12 lead in the field, I would just put the electrodes on the torso for III lead. But when we started doing the 12 lead I did put them on the extremities, if possible.

When it came to dealing with "extra weight" patients, sometimes you do have to lift and push and separate things. You have to be aware of your lead placement and compensate to be accurate. I know it sounds bad, but you have to "get in there" and under the rolls.

Now when it comes to large breasted women, I think that's another topic.

[MSDeltaFlt]

I'm a coronary Care Unit nurse and all the points above are the rationale for why I lay my patient back for acquisition of a 12 lead. Standing up adipose tissue *hey I'm being polite not to say large amounts of fat lol* droops downwards so it can give misplacements of the leads. Laying flat/flatish, allows the excess to droop to the side allowing adequate placement of the leads in the positions around the heart.

Question though, and I do both techniques dependent on situation.... when you are placing the limb leads, do many people place them on the torso also? Or go for the wrists or ankles. I do both as I said dependent on situation (if my patient is attached to the 12 lead consantly in their initial arrival to the unit, I will use the torso, for intermittant 12 leads and once a day acquisitions, I will use the limbs.)

Scotty

Celticare,

It depends on what you want to do with your ECG. Do you want to monitor or assess? If you just want to monitor, then the torso works fine. RA is close enough when on Right Upper Torso. You won't be able to assess as accurately, but you won't be assessing.

If you want to assess, then you will have to place the leads on the limbs. On assessment, lead placement is paramount. Limb lead placdement on the torso can result in false positive ST elevation. RA means Right Arm.

Hope this helps.

[chbare]

Consistency is also very important. This is especially true when performing serial XII leads. It is not helpful when you have people placing leads differently on the same patient. We want consistent placement in order to identify actual changes.

Take care,

chbare.

[pguy280]

Great topic and responses. I found that having a patient supine or in a relaxed position allows the electrodes full contact without having the normal skin movement interfere with a tracing. Just my two cents as a newbie.