What are the Best Tips for EKG Lead Placement?

Vanessa Harvey

The best tips for electrocardiogram (EKG) lead placement include reviewing the equipment before having to use it, becoming familiar with the electrodes employed by the emergency medical services (EMS) system in question and knowing the importance of preparing the patient's skin. Studying diagrams that show correct EKG lead placement, memorizing that placement and getting lots of practice also figure among the best tips. Many advanced life support (ALS) systems have embraced a routine use of a 12-lead EKG in the field. Use of a 12-lead EKG is more complicated than working with only three leads.

A man getting an EKG.
A man getting an EKG.

Reviewing the equipment, knowing how to turn on the monitor and how to plug in the monitoring cables or "leads" and attach them to the electrodes helps medics to prepare for emergencies. Good preparation almost always results in smoother and swifter operations when skill and knowledge must be employed under stressful situations. EKG lead placement should be on dry, bare skin because moisture, oil and excessive hair can interfere with the noninvasive recording of the electrical activity of the heart. It is sometimes necessary for one to use a cloth to wipe a patient's skin dry or to shave hair where a lead will be placed.

A 3-lead EKG is often used to continuously monitor the heart rate and rhythm of a critically ill patient.
A 3-lead EKG is often used to continuously monitor the heart rate and rhythm of a critically ill patient.

Consulting diagrams or watching training videos that demonstrate correct EKG lead placement helps to prepare a student of emergency medicine or of paramedicine for hands-on skills practice. The study of diagrams, however, cannot take the place of real-life experience in the field. EMS systems are not standardized, so it is important for one to follow local protocols regarding everything, including EKG lead placement. Any tip that is in disagreement with local medical direction should be disregarded.

If an EMS system uses only three leads, it might be helpful simply to memorize placement by color. The white electrode goes under the center of the right collarbone, the red one is placed on the left lower chest, and the green or black electrode goes over the lower right chest or over the center of the left collarbone. Some medical professionals prefer to place electrodes on each of the four extremities.

Abbreviations also help with EKG lead placement on extremities. They are: "RA" for the right arm, "LA" for the left arm, "RL" for the right leg and "LL" for the left leg. Placement with a 12-lead EKG is made easier by learning where lead V1 and V2 go and continuing with placement from the point of the V2 lead. Following a slightly curved imaginary line that traces under the breast to below the armpit is helpful when working with the 12-lead system.

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