Can I place tele leads on a pt’s back?

[Boardten]

I had a confused patient that kept pulling the leads off. The nurse before me placed them on their back and that seemed to solve the problem. Patient didn't pull them off and we still could read the rhythm on our monitor so I just went with it. Of course it wasn't ideal, but is it ok for like a "do what you gotta do" kind of thing?

[NICU Guy, BSN, RN]

Surgery does it all the time when they are doing surgery on the chest.

[Boardten]

Ah very nice. Thank you.

[offlabel]

If all you want is to see the rate and presence or absence of things like the QRS or p waves and their morphology, then it doesn't matter where you put the leads. If you're trying to make a specific diagnosis, it would not be sufficient because it could introduce artifact like big or weird T waves even ST segment artifact.

[Rose_Queen, BSN, MSN, RN]

Yep, we've gotten creative in cardiac surgery since we need access to the full chest. Same with thoracic when we need access to front and back of one side. It's possible to work around.

[Julius Seizure]

You just need to be aware of what leads are looking at "where", so that you know how the waveform should look - and monitor for changes.

[SummitRN, BSN, RN]

Consider also how long you are leaving them on. If they are going to be laying on the leads and are at risk for skin breakdown, there is increased risk if they are laying on them for 24 hours.

[nurs1ng]

Can anyone tell me how you would position each lead on a patient's back? Thanks.

[SummitRN, BSN, RN]

Can anyone tell me how you would position each lead on a patient's back? Thanks.

When we prone patients in the ICU, we'd place the leads the exact relative placement as if they were anterior.

Remember this is for telemetry monitoring, not diagnostics.

For surgery, or in your case, you tend to move them toward the RA/LA leads superior and the RL/LL leads so they are receive less direct pressure. The V lead you can probably still place in the V6 position.

Just remember for two lead evaluation, a posterior "II" and psuedo V6 won't have the advantage of monitoring II/V1 to see obvious axis shifts to differentiate A vs V tach at a glance and your QRS morphology is going to be a bit different, but good enough for monitoring.

[SummitRN, BSN, RN]

in your case, you place leads posterior in the relatively the same position as anterior but move RA/LA leads superior and the RL/LL leads LATERAL so they are receive less direct pressure and catch less. The V lead you can place in the V6 or V7 position.

Fixed

Also, anticipate increased motion artifact because little movements rub the gel contact points as it catches on the sheets (not a problem in surgery).

[nurs1ng]

Thanks for this. In our ICU, we utilize the EASI lead placement and though I know that back placement is not ideal for diagnostics, I wanted to make sure that this was still feasible. Thanks again.

[SummitRN, BSN, RN]

I haven't tried it with EASI and cannot advise how moving from the prescribed lead positions with alter the interpolated 12 lead. Let us know!