Alright guys, we're here today to talk about ECG Lead placement and our actual technical aspects of that.
First, you'll notice we have all our supplies gathered.
We have gloves, alcohol preps, electrode strips, and our actual machine.
We're going to go ahead and the first thing we always do is identify our patient.
(The male patient provides his name: "Bob Smith").
Notice, I did not ask if his name was Bob Smith because disoriented patients tend to agree with anything.
So, I'm going to wash my hands, which I've done off set.
And, I'm going to place my gloves because I am most important and my safety comes first.
So, even though this isn't an invasive procedure, we still always wear gloves.
Alright, so next, I'm going to take my alcohol preps.
We do use alcohol preps to clean our lead sites because it both helps with adhesiveness and preps the patient.
We don't...it's not an invasive procedure, but we are still going to use them to cleanse.
So, I'm going to come over to my patient.
Now, as you noticed in your book, when we place a twelve lead, we place a lead on each of the four limbs.
And, we place our six precordial leads.
So, what we're going to do is we are going to first start with the limb lead placement.
And, the general area that we can place on the limb is the inside of the wrist.
But, if it looks like we're having some issues with that, we have trembling of the patient
or anything like that, we can also have an alternative site here near the shoulder, closer in.
So, right here on the inside of the wrist.
Now, you're going to see a couple of different types of electrodes.
The ones we have today, we're always going to peel off and we want the tab facing up towards the heart.
The place is right here.
Now, we're going to prep our other arm.
Same placement, tab facing up.
Place our lead up towards the heart.
Alright, make sure I'm getting good, firm seal.
Now, we can do the same with the legs.
We can move up towards the hips, if we're missing a limb or if we're having some issues with leg tremors.
Place the tops of the ankles is the general recommendation.
And, we're going to place our tab facing up.
We want to make sure we get a good seal here.
Our last lead on the top of the ankle.
The American Heart guidelines for this are that you can place anywhere on the arms and the leg.
But, this is the...usually both your easiest access point and what we see in our book.
So, we'll follow our book.
Now, I'm going to move on.
We've gotten these placed.
Now, some of your machines you can hook up just the four leads first.
And, then a top grounding lead.
But, with this machine, we have to hook up both our twelve chest leads and our limb leads at the same time.
So, I'm going to go ahead and place our precordial leads.
Alright, so I'm going to come down.
Now, on some gentlemen that have a hairy chest, we will want to shave just the areas where
we're going to place our limb leads.
I'm going to come down here and I'm going to count down four intercostal spaces.
So, one, two, three, four.
I'm going to cleanse my site.
I'm going to put what's referred to as V1 right here.
Here the tabs are facing down.
When we face them up, the electrodes tend to peel back.
Now, I'm going to go on the other side of the sternum, same area.
Cleanse my site.
Place my (inaudible).
Now, it may seem counter-intuitive, but I'm actually going to use my placement for V4
next, which is going to be midclavicular line and along my fifth intercostal space.
So, I'm going to go one space down.
And, then I'm going to find it with my finger.
And, I'm going to place it right there.
Now, I have a reference for V3.
Cleanse.
And, I'm going to place V3 in between V2 and V4.
Now, V5 is going to track right along that fifth on intercostal space.
And, then V6, our final lead.
Now, that we have everything placed, we can go ahead and hook up our leads.
Don't panic about forgetting which lead goes where because they actually have it diagrammed
for you very nicely right on our control.
So, we can split this into two to try to avoid tangling.
Alright, now remember when we're working with right arm and left arm, it's going to be the patient's right not our right.
So, this says RL which is Right Leg.
Go ahead and place it right here.
And, this is RA.
So, Right Arm.
Alright.
Now, this one says LL for Left Leg.
Here we have LA.
Now, that I have my limb leads positioned, I can move on.
You're going to notice I have V1.
Go ahead and place V1, V2, V3, V4, V5, and V6.
Alright, I'm going to place this up here.
Now, as you remember from Chapter 3, we learned about Einthoven's Triangle.
And, that can help us identify if we're having issues with any of our leads.
I'm going to walk over here.
I'm going to go to patient info.
And, I'm going to use my information from the requisition form to enter Bob Smith and
the birth date that I see on the form and that he gave to me.
Alright, now I'm going to go and I'm going to press the start/stop button.
And, I'm going to press it one more time.
After I've looked here, everything seems to be appearing normally in my window.
I'm going to allow the machine to analyze and collect the data and print my results.
And, we see in here that he is in what appears to be normal sinus rhythm.
And, that is how we do a traditional twelve lead.