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.

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.

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

EKG MACHINE

EKG KEYBOARD

Lead Wires and Electrodes

Different Attachment
Types, may clip or
button

EKG lead wires

EKG electrodes
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Performing the EKG

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Enter Patient Data

Last name

First name
ID number (Medical record #)

Age
Gender

Be sure to identify
patient as per
NSLIJHS policy

Referred by (Name of prescriber)

Technician (Your name or initials)
Location (Each unit is designated a location #)
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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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Electrode Placement
Underlying Structures
Heart Surfaces

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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)
V4 = 5th ICS,
at mid-clavicular line
V5 = 5th ICS,
at anterior axillary line

V6 = 5th ICS,
at mid-axillary line
V1 = 4th ICS,
at right sternum border

V2 = 4th ICS,
at left sternum border
V3 = Equidistant
between V2 & V4

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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
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Video on 12 Lead EKG Placement

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

EKG Waveform

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Normal 12 Lead ECG Good Quality

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Poor Quality EKG Tracing

EKG WITH WANDERING BASELINE

MUSCLE TREMORS

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Poor Quality EKG Tracing

EKG WITH PATIENT MOVEMENT

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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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References
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

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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/NursingQu
izSystemSYS.aspx?user_facility=system&user_quiz=systemEKG-Lead

Passing score = 100%

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