EKG Help: 3 vs 5 vs 12 lead

Editorial Team / Admin · Jun 16, 2009

3-lead is usually used on transport monitors, and monitors two different areas of the heart (one lateral, two inferior).

5-lead is preferred in an ICU, to monitor the third (anterior) area. For example, if your pt is admitted as a r/o MI (rule out Myocardial Infaction = suspicion pt is having a heart attack), with the 5-lead you can keep an eye on the three areas of the heart and if you see changes in any of the leads (especially if accompanied by chest discomfort or vomiting or VS changes), you can (per protocol, hopefully) get a 12-lead ECG.

12-lead ECG gives a more detailed look at the heart's three areas (anterior=front, lateral=side, inferior=back), and changes in certain segments of the ECG in the related leads for each area suggest the area of concern. For example, ST changes in leads II, III and aVF may suggest a problem in the right coronary artery.

Hope that helps. I'm sure others may chime in; getting different ways of explaining things is helpful. :)

nursej22, MSN, RN · Jun 17, 2009

We also use 5 lead EKG in PCU. Lead II is typically used to determine HR and to identfy a P wave, and the chest lead can be placed over a specific area of concern, say heart muscle supplied by a newly stented artery.

12 lead EKG is also used to identify Axis and specific bundle branch blocks. You may have an irregular rhythm with a wide QRS complex--a 12 lead can be useful in distinguishing a fib with aberrant conduction from v tach.

lpnstarstudent · Oct 8, 2010

Are there areas still using 3 lead for transport?? That's not good! I know in our area, all transports vehicles whether it be fire dept medic or hosp transport, all have 12 lead monitors and all (yes even medics) can diagnose MI's in the field and call cardiac alerts on their own without a physician or nurse. In our area this ability has saved countless lives. To give you an average time to treatment example; from 911 dispatch with pt ariving directly to cath lab is 30-45 minutes. INCREDIBLE! Sorry I did not answer the orignal question. I got side tracked with 3 lead monitors.

Lovelymo79 · Oct 8, 2010

I'm a nursing student interested in cardiac nursing. I worked on a cardiac floor for a year as a nursing assistant and floated to ICU a lot. In the ICU and on the floor, we used the 5-lead monitors.

I now work in the ER as a tech. I do the 12 EKGs on patients with chest paid/discomfort. Afterwards, I hook them up to the 5-lead monitor.

In both the ER, tele floor and ICU, they still use the 3-lead monitor for transport.

CCL RN, RN · Oct 11, 2010

Are there areas still using 3 lead for transport?? That's not good! I know in our area, all transports vehicles whether it be fire dept medic or hosp transport, all have 12 lead monitors and all (yes even medics) can diagnose MI's in the field and call cardiac alerts on their own without a physician or nurse. In our area this ability has saved countless lives. To give you an average time to treatment example; from 911 dispatch with pt ariving directly to cath lab is 30-45 minutes. INCREDIBLE! Sorry I did not answer the orignal question. I got side tracked with 3 lead monitors.

Absolutely transports are using 3 leads and actually there is nothing wrong with that. Yes, all medic trucks have 12 lead ecgs, but that's for a snapshot, not for monitoring. You don't keep someone on a 12 lead for transport!

12 leads are the gold standard for Dx STEMIs. As soon as our medics see the STEMI, I get paged from my lovely slumber to rush to the cath lab at 2am. But door to cath time is irrelevant, what matters is door to device (balloon, stent, export) time. However, even with STEMIs, they are still transported via 3 lead monitoring.

hohulin · Mar 31, 2012

I am interested in telemedicine. there is a ECG monitor (2 lead) now available http://alivecor.com/index.htm

I would be interested in any research on the value of 2, 3, 5 and 12 leads. How many false positives, false negatives accurate diagnosis are determined based on the number of leads for an ECG.

psu_213, BSN, RN · Mar 31, 2012

Are there areas still using 3 lead for transport?? That's not good! I know in our area, all transports vehicles whether it be fire dept medic or hosp transport, all have 12 lead monitors and all (yes even medics) can diagnose MI's in the field and call cardiac alerts on their own without a physician or nurse. In our area this ability has saved countless lives. To give you an average time to treatment example; from 911 dispatch with pt ariving directly to cath lab is 30-45 minutes. INCREDIBLE! Sorry I did not answer the orignal question. I got side tracked with 3 lead monitors.

When you say 'transport' I think of transport within the hospital...i.e. to CT scan, from the ER to the floor/ICU, etc. For that transport I cannot see why 3 lead is not, generally, ok. For instance, does HR/rhythm of a pt on a dilt gtt. remain stable during transport in the hospital?

In our area, most medics will do 12 leads if their is any suspicion for MI and then fax the EKG either to medic command or to the receiving ER.

In the hospital I have seen 12 leads used for any suspected MI/any pt with new chest pain, a new arrhythmia, any pre op (even if not a cardiac case), any time the doctor wants exact measurement of the intervals (for example, after the pt starts on the A fib drug tikosyn). In the ER, 12 leads are used for most SOBs, abd pain in the elderly, high blood pressure, someone exhibiting S/S of CHF, dizziness, syncopal episodes, and, well, almost anything else (OK, usually not sprained ankles). 5 leads for telemetry, 3 lead for in-hospital transporting.

turnforthenurse, MSN, NP · Apr 4, 2012

dianah explained it well :) 3 leads are used on transport monitors and are typically used on patients from coming from the ER to the ICU stepdown or ICU. On my floor (progressive) and ICU, we use a 5-lead. If a patient from our progressive unit or ICU goes down for a test, they stay on the monitor. Some nurses will unhook patients from monitors (from PCU) but I prefer mine to be on the monitor at all times, unless there is a contraindication (such as an MRI). When they go down for tests, they stay on our 5-lead monitor. If a patient complains of chest pain or goes into sudden A-fib with RVR or has a run of v-tach, we automatically order a 12-lead EKG per protocol.