12 Lead Ecg Placements

12 LEAD ECG PLACEMENTS
The Heart
All heart muscle is capable of conducting an electrical impulse and initiating a
spontaneous electrical discharge.
The 12 lead ECG is a graphical representation of this activity.
A 12-lead ECG paints a complete picture of the heart's electrical activity by
recording information through 12 different perspectives. Think of it as 12
different points of view of an object woven together to create a cohesive story -
the ECG interpretation.
These 12 views are collected by placing electrodes or small, sticky patches on the
chest (precordial), wrists, and ankles. These electrodes are connected to a
machine that registers the heart's electrical activity.
1. The Iso Electrical Line This represents the resting potential of the heart. The
electrical events of the cardiac cycle will be represented by deflections away from
this line.
2. SAN Depolarisation End of Iso Electrical Line

3. Atrial Depolarsiation (P Wave)
4. Atrial Contraction (P Wave)
5. AVN depolarisation (PR Interval)

6. Specialized conducting tissue (QRS Complex)
7. Ventricular depolarization (QRS Complex)
8. Ventricular contraction (QRS Complex)

9. Ventricular Repolarization (T Wave)
Who Should Have a 12-Lead ECG

The main purpose of the 12-lead ECG is to screen patients for possible cardiac
ischemia. 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.
Preparing a Patient for an ECG

1. As with all procedures, we should obtain informed consent from the patient;
explaining the purpose of the procedure; the procedure itself and obtaining
consent to proceed. Maintain good infection control practice by washing your
hands prior to patient contact.
2. Skin preparation is important. If the patient’s skin is dirty, clean with soap and
water, and then dry. If the skin is oily or the patient applied any creams or
lotions, use an alcohol wipe to clean each electrode placement site.
3. Some ECG machines may also provide a ‘rough patch’ either separately or on the
electrodes, which can be used to rub on the skin to increase electrode adherence,
but care should be taken not to cause abrasions.
4. Patients with chest hair should have hair at the electrode placement sites
removed with a razor (Coviello 2016).
5. Where possible, place the patient in a semi-recumbent position(Baillie 2014).
If this is not possible or uncomfortable for the patient, it is acceptable to record
the ECG in another position.
6. The patient must be completely relaxed. Ensure the environment is at a
comfortably warm temperature (Jevon 2010). This will prevent muscular tension
or movements producing artefact on the ECG recording. Ensure privacy and
dignity: e.g. closing the room door or drawing around the curtains.
Equipment’s
 ECG Machine
 Recording Paper
 Electrodes
 Conduction gel
 Clippers
 Alcohol swab or pad
Procedure Preparation Of Equipment

 Place the ECG machine close to the client's bed and plug the cord into the wall
outlet or, batteryoperated, ensure that it is functioning.
 Turn on the machine and input required client information.
 Check that machine settings are standard
Verify the Physician order.

Indentify the patient
Provide privacy and explain the procedure to the client. Explain that the test
records the heart's electrical activity and that it may be repeated at certain
intervals. Emphasize that no electrical current will enter the body. Tell the client
that the test typically takes about 5 minutes.
Perform hand hygiene.
Advice the client lie supine position in the center of the bed with arms at his
sides. You may raise the head of the bed to promote comfort. Expose the arms
and legs and cover the client appropriately. The arms and legs should be relaxed
to minimize muscle trembling, which can cause electrical interference. Make sure
the feet are not touching the bed board.
Select flat, fleshy areas to place the limb lead electrodes, Avoid muscular and
bony areas. If the client has an amputated limb, choose a site on the stump.
If an area is excessively hairy, clip it. Clean excess oil or other substances from
the skin with alcohol pad to enhance electrode contact
Apply disposable electrodes to the client's wrists and to the medial aspects of the
ankles.
Expose the client's chest. Put a pre-gelled electrode at each electrode position. If
your client is a woman, be sure to place the chest electrodes below the breast
tissue. In a large-breasted woman, you may need to displace the breast tissue
laterally.
Chest (Precordial) Electrodes and Placement
The patient’s chest and all four limbs should be exposed in order to apply the
ECG electrodes correctly.
» V1 - Fourth intercostal space on the right

sternum
» V2 - Fourth intercostal space at the left
sternum
» V3 - Midway between placement of V2
and V4
» V4 - Fifth intercostal space at the
midclavicular line
» V5 - Anterior axillary line on the same
horizontal level as V4
» V6 - Mid-axillary line on the same
horizontal level as V4 and V5
Limb Lead Placement

Connect the lead wires to the electrodes. The tip of each lead wire is lettered and
color coded for easy identification.
Limb (Extremity) Electrodes and Placement
» RA (Right Arm) - Anywhere

between the right shoulder and right
elbow
» RL (Right Leg) - Anywhere below
the right torso and above the right
ankle
» LA(Left Arm) - Anywhere
between the left shoulder and the left
elbow
» LL (Left Leg) - Anywhere below
the left torso and above the left ankle
Additional notes on 12-lead ECG Placement:
 The limb leads can also be placed on the upper arms and thighs. However, there should be
uniformity in your placement. For instance, do not attach an electrode on the right wrist and
one on the left upper arm.
 For female patients, place leads V3-V6 under the left breast.
 Do not use nipples as reference points in placing electrodes for both men and women as nipple
locations vary from one person to another.
When the machine finishes recording the 12-lead ECG, remove the
electrodes and clean the client's skin
After disconnecting the lead wires from the electrodes, CLEAN & DRY the
electrodes as per manufacture instruction.
Assist the client to a comfortable position.
Ensure the bed is in a low position.
Remove any remaining equipment and wash your hands. Label ECG recording
with
 Patient’s name
 Medical record no
 Date
 Time
 Signature
Document the procedure in Nurses notes .
References:
https://www.ausmed.com/cpd/articles/ecg-lead-placement
https://ecg.utah.edu/lesson/
https://www.slideshare.net/jeya81/nursing-procedure-obtain-12-lead-ecg
https://www.cablesandsensors.com/pages/12-lead-ecg-placement-guide-with-
illustrations
College of Nursing
12 LEAD ECG PLACEMENTS
NCM 106 RLE
Submitted By:
GROUP #2
Cariaga, Naomi Mari
De Guzman, Viel Romina
Falusi, Blessing Olaide
Fukami, Shaina Joan
Fullo, Nolah Mikhaela
Hernandez, Audrey
Ibrahim, Uswat Olaide
Legaspi, Jelvin R.

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What are the steps to properly place the electrodes for a 12-lead ECG?

What are the steps to properly place the electrodes for a 12-lead ECG?

What are the placements for the chest (precordial) electrodes?

What are the placements for the chest (precordial) electrodes?

12 LEAD ECG PLACEMENTS

2. SAN Depolarisation End of Iso Electrical Line

4. Atrial Contraction (P Wave)

5. AVN depolarisation (PR Interval)

7. Ventricular depolarization (QRS Complex)

8. Ventricular contraction (QRS Complex)

Who Should Have a 12-Lead ECG

Preparing a Patient for an ECG

Procedure Preparation Of Equipment

Verify the Physician order.

» V1 - Fourth intercostal space on the right

Limb Lead Placement

Limb (Extremity) Electrodes and Placement

» RA (Right Arm) - Anywhere

12 LEAD ECG PLACEMENTS

NCM 106 RLE

Cariaga, Naomi Mari

De Guzman, Viel Romina

Falusi, Blessing Olaide

Fukami, Shaina Joan

Fullo, Nolah Mikhaela

Ibrahim, Uswat Olaide

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