Am I missing something here?

[Guest219794]

hey cardiac nurses-

i posted this over in er, but would like your take on it. i don't know if it is a faux pas to double post, but:

two recent incidents make me question some stuff.

1. a friend who is a new grad being oriented into the icu of a cardiac center seems to be given bad information. she uses a 5 electrode system, and believes the the brown electrode is a ground, and can be put anywhere on the chest. i explained that the brown electrode is more likely a v lead, and can be placed in a number of positions, the most common being v1-v6. i explained a couple of reasons one might want to choose where to monitor. she seems a little skeptical, as she is being precepted by one of the more experienced nurses there, and what i explained to her seemed pretty basic.

i have seen this in the icu, where most of the nurses i worked with, put the brown electrode in a random spot, and only monitored the inferior heart through lead ii.

2. had a pt last night who's primary complaint was respiratory- no chest pain, but multiple risk factors. ekg showed depression in leads v5-6. so- i set the monitor up to monitor lead v6 as the primary lead. figured i might want to know if any treatment i gave resolved the ischemia. also figured if there was going to be any elevation, that might be a good place catch it. while i wasn't watching, somebody mpved my brown electrode to the middle of the chest-somewhere between and below v1-v2. (right at shift change i got a positive troponin)

am i missing something here? this can't be all that complicated, as i am not all that well educated or experienced. it seems rare that i encounter other nurses who know this stuff. why is that?

any thoughts?

[Boog'sCRRN246, RN]

I'm not a cardiac nurse, but I was taught very specific locations for the brown electrode (4th ICS, R or L sternal border or at v6 position). The green electrode was always the ground and could be placed in a "convenient" area.

[al7139, ASN, RN]

I don't know if this will help, but I am on a tele unit and we use the 5 lead monitors. We place them like this: V lead in the mid sternal chest White on right chest wall over green abdominal lead, Black on left chest wall over red abdominal. What you get looks like the five dots on a dice game piece. Our tele boxes also have diagrams to show where to place them, but keep in mind that you may have to make adjustments for hairy chests, and implanted devices like pacemakers and aicd's (don't put a lead over these). Lead II is what is most monitored in tele units, and our techs look at all the lead options and alert us to abnormals, but we were taught that if it looks strange to run a complete 12 lead EKG to confirm.

Amy