Electrocardiogram (ECG) is graphical recording of heartbeat. This test is used to check the patient’s heart activity and to diagnose many coronary heart diseases or heart arrhythmia. There are a total of 10 ECG leads placed on the patient’s body 6 of them are chest leads fixed on the patient’s chest while the other 4 are placed on shoulders and legs. Position of leads must be correct otherwise you will get improper results.
Preparing the Patient:
- Ask the patient to recline on their back: It’s necessary for the patient to lie on their back to take the ECG test. This position helps the doctor to find the correct places for situating the ECG leads and also keep the patient’s heart beat at resting rate. If you’re in the clinic, ask the patient to lie down on the back of the examination table. If you’re giving an ECG test at home then lay back on your bed or couch.
- Gain verbal consent to the procedure from the patient: Tell the patient about the whole procedure of ECG test to gain confidence of your patient. Explain that 10 leads are placed on your body to electrically monitor their heart beat. Tell them that the procedure isn’t painful. Tell them not to move while lead is placed because leads should remain attached to the skin for 3 to 5 minutes. Tell the patient to take long deep breaths and remain relaxed during the whole procedure. If the patient is female then maybe she is comfortable with the female doctor or nurse for placing the ECG leads on her chest.
- Clean the patient’s chest before you place the leads: Patient’s skin should be free from dirt or oil before placing ECG leads. Clean the skin from soap and water and dry it with the towel. Clean surface is very important to note ECG recordings because oil or dirt can interfere with the electric signals and cause disturbance in readings. It’s hard to stick a lead to the dirty skin. If the patient has hairs on his chest then it’s necessary to shave off all the hairs because it also causes disturbance in ECG readings. If you don’t have soap or water then you can also use alcohol cleaning pads to clean up the skin from dirt or oil. Wash your hands or wear latex gloves before placing ECG leads.
2. Positioning the Chest Leads:
- Unpack the ECG leads and read the color-coding system: There are 10 ECG leads used to record heart beat. 6 are chest leads that place on your chest which are referred to as “V” leads. They are numbered from V1 to V6. V1 is the first lead to place on the chest and V6 is the last one. The other 4 leads are placed on the patient’s arms and legs. They are packed separately from the chest leads in the box to avoid confusion. All these ECG leads are differently color-coded to differentiate each lead from the other. There is a color coding chart on the box to know which color represents which leads.
In chest leads:
- Red represents V1.
- Yellow represents V2.
- Green represents V3.
- Blue represents V4.
- Orange represents V5.
- Black represents V6.
In body leads:
- White represents RS lead.
- Black represents LS lead.
- Green represents RA lead.
- Red represents LA lead.
- Find the “angle of Louis” to determine chest electrode placement: Chest leads placed according to the angle of louis. To find the angle of louis, put your fingers beneath the patient’s throat and slide your finger down until you reach the top of the sternum. Slide down more 5–6 inches (13–15 cm) until you reach the sternum. This part is the angle of Louis where the 4th rib is attached to the sternum. By knowing the angle of Louis, this will help you to place ECG chest leads. If the patient is lying down on their back, It’s easier to find the angle of louis. You can also practice on your chest before finding it on the patient’s chest.
- Place V1 between the patient’s ribs on the right side of their sternum: Place V1 chest lead between patient’s 4th to 5th rib, count it down from the top. If you face difficulty to find the 4th or 5th rib then slide your finger right to the angle of louis. As you move right, you’ll feel a gap between the patient’s ribs. Slide down 1 more rib to the next rib gap. This is the place where V1 chest lead should be placed. Lead is slightly adhesive, put little pressure on lead to stick it on your skin.
- Set V2 across the patient’s sternum from V1: For V2, slide your finger left to the angle of louis until you feel a gap then slide down 1 more rib to reach the next gap. Now place the V2 chest lead close to the sternum between the rib’s gap. V2 will be placed on the mirror position of V1 lead on the left side of the sternum.
- Position V4 beneath the midpoint of the patient’s left clavicle: For placing V4, slide down your finger 1 rib more from V2 position and slightly move right to it and place V4 chest lead between the gap of 2 ribs. V4 placed under the midpoint of Patient’s left clavicle. Clavicle is the collarbone.
- Set V3 directly between nodes V2 and V4: Place V3 lead between the V2 and V4. It is placed directly over the patient’s rib.
- Situate V5 at the same height as V4 below the patient’s axilla: V5 placed beneath the patient’s underarm. Slightly move to the right of V4 into the gap between the rib and press the V5 leads at the same height as V4 beneath the patient’s axilla (underarm).
- Set V6 directly under the center of the patient’s left underarm: Continue moving your finger right to the V5 along the gap between 2 ribs until you reach the center of the patient’s axilla. Place V6 here below the patient’s underarm in the rib’s gap.
3. Setting the Extremity Leads:
- Stick 1 lead to the patient’s right shoulder below the clavicle: Place the RS lead on the patient’s right shoulder just 2 inches or 5.1 cm below the right clavicle. Press the RS lead firmly to stick on the skin.
- Press 1 lead onto the left shoulder below the clavicle: Place LS lead same position as RS lead but in opposite direction. Place LS lead on the patient’s left shoulder 2 inches below the left clavicle.
- Fix a lead onto a fleshy spot on the patient’s right ankle: Place RA lead on the fleshy part of patient’s right ankle. Make sure not to place RA lead directly onto the ankle bone. If a patient wears socks then remove it first.
- Press a lead onto the patient’s left ankle below the ankle bone: Place LA lead on the same position where RA leads are placed but in opposite direction. Place LA lead onto the patient’s left ankle below the ankle joint.