ECG lead placement for large breasted women

[Cidneysue]

Correct lead placement on females with large breasts...... on breast or under?  PLEASE help me and provide resources for the answer.  I have an opinion but need resources as a go to.  

 

THANK YOU!  

[HarleyGrandma, RN, EMT-B]

The leads need to be placed to accurately capture the electrical activity of that particular heart. Some times the shape will require placement under the breast, and sometimes across the breast. If you focus on placing the leads in relation to the heart, and not the breast (or body fat) it becomes easier.

https://pubmed.ncbi.nlm.nih.gov/9533374/

Quote

Breast tissue appears to have a practically negligible effect on ECG amplitudes, and in women, the placement of chest electrodes on the breast rather than under the breast is recommended in order to facilitate the precision of electrode placement at the correct horizontal level and at the correct lateral positions.

 

[speedynurse, ADN, BSN, RN, EMT-P]

I placed the leads under the breast and held it up while I obtained the EKG. Perhaps slightly awkward but it’s imperative to place the leads correctly to avoid missing a STEMI.