#HEART MONITOR LEAD PLACEMENT HOW TO#

So, if you thought we placed electrodes on the patient’s chest to cut down on artifact, you were correct … sort of. The nurses then taught some paramedics this “trick,” and the paradigm was born. Instead, an “alternative” placement on the chest was adopted so nurses could leave the room without worrying about artifact. A monitor tech watches the monitors, and if something changes, the nurses are called back to the room.Īfter a few “false code” events from patients moving their arms to brush their teeth, which looked like V-fib if you weren’t in the room to see what the patient was doing, the nurses realized that limb-lead placement wouldn’t work in an unattended telemetry setting. Telemetry allows nurses to put patients on a monitor and then leave the room to care for other patients. It stems from the installation of telemetry in the hospital. I’ve asked nurses and paramedics why we do this, and I think I found an answer “¦ other than the usual, “Well, that’s the way I was taught,” response. And, although the leads had the placement noted on the wire–”LA” for left arm, “RA” for right arm and “LL” for left leg–some providers still put them on the chest. This method has carried over even with the 4-lead monitors we have now. In the beginning, we had 2- or 3-lead monitors, and learned lead placement by such sayings as: “white right, red bed,” or “smoke over fire.” This simply meant that we put the leads on a patient’s right upper chest, left upper chest and under the last rib on the patient’s left side. In this article, I’ll explain proper lead placement. We cannot continue to place leads in the monitoring position (with limbs leads on the chest) while expecting to run a diagnostic 12-lead. The issue then becomes proper lead placement. But has the shift from putting patients on the monitor to running a 12-lead caused us to miss something? With some nationwide programs educating providers on the importance of early 12-leads and recognition of ST-elevation myocardial infarction (STEMI), it will become an expectation that all prehospital providers perform 12-leads ECGs–even those who never have before. Instead of putting patients on the monitor, we’re “throwing down tradition” and running the 12-lead first in an effort to triage those patients with acute coronary syndromes.

Prehospital cardiac monitors are now also 12-lead machines, and modern EMS systems utilize 12-lead ECGs on a regular basis. However, is this lead appropriate for all patients? Should we be monitoring other leads? These traditional exams have established a paradigm of lead II monitoring in patients.

#HEART MONITOR LEAD PLACEMENT HOW TO#

Lead II has traditionally been the most commonly used monitoring lead since its appearance in 1910 with Willem Einthoven’s invention of the electrocardiograph.1 Paramedics are taught how to interpret rhythms in lead II, and this skill is tested on the standardized exams given at the state and national levels.

Changes, such as V-fib and asystole, demand immediate assessment of the patient’s pulse and breathing. The purpose of ECG monitoring is to “monitor” a patient’s heart rhythm and detect changes that could be life-threatening. Fontaine lead has been designed to improve visualization of Epsilon wave in arrhythmogenic right ventricular dysplasia.Cardiac monitoring is a fundamental ALS skill that’s frequently used in the prehospital and hospital settings. Lewis lead and the newly devised modified limb lead system are useful in enhancing detection of atrial activity. EASI lead system permits derivation of 12 leads from just five electrodes. Lund system with leads on proximal part of limbs have both stability and fair diagnostic value. Mason-Likar modification with limb leads shifted to the torso is popular for exercise testing, though the diagnostic value of the ECG is altered.

Lead stability is important when the movement of the subject is maximum as in exercise testing. Using five leads gives the option of getting a chest lead in addition to bipolar limb leads, enhancing detection of ischemia during procedures. This can be used to record modified bipolar chest leads as well. Simple three electrode bipolar recording is ubiquitous for monitoring. The need for different types of lead systems in different settings has been emphasised. ECG monitoring is common place in the hospital and even pre-hospital setting.

Heart monitor lead placement