EKG Lead Placement

We have always used white on the right chest, black on the left chest and red on the belly. When we use limb leads we do the same except the red goes on the leg. It doesn't pick up the most accurate resps, but they save their skin. You can also place them on the back in the same fashion. Where else are they putting them? If the leads aren't on right, we just change the lead pattern (Lead I, Lead II, Lead III, etc) to get what we need.

Depolarization wave moving toward a positive lead will be upright.

Depolarization wave moving toward a negative lead will inverted.

Depolarization wave moving between negative and positive leads will have both upright and inverted components

I hope this helps

That is fabulous! Thank you so much!

Some nurses place the leads under the nipple buds, other place them to the lateral aspects of the nipple buds, still others place them medially, etc...

Hopefully this will help us have some consistency! Thanks!

We do move them to all those places also to keep skin intact, but as long as you have the basic diagram it will work :)

I still remember my preceptor telling me "White goes right and smoke (black) above fire (red)". It works for me:) As long as they are in that basic pattern, the pickup should be ok. There is no reason to be superpicky about it.

Don't you love when you come on shift and they're all on the stomach?

Me too!!! Gaaahhhh! What is the point? You just make it worse! :angryfire

This doesnt have anything to do with babies, but lead placement has become more important as they try to find different areas for law suits.

I read where a patient died of sudden cardiac arrest. His chart was sequestered 4 months later and they said he had multiple cardiac changes shown on his ekg tracings. The changes were due to various placements after his baths and lead electrode changes. The hospital settled, but when you place leads in different areas, it can show a slight change on the ekg.

Now that is scary! I never thought of that with adults!

I think the reason there has been so much discussion on our unit (and why I posted the original question) was because of the possibility of lawsuits....and we have one really picky Neonatologist! All in all, I just want to make sure that we are getting the most accurate tracing possible!!

I agree that coming in and finding that some sweet nurse has tied the lines in a big ol' knot (so they stay nice 'n neat) is quite a pain in the rear...we've actually had a couple of instances where the knots were tied so tightly that the wires snapped and poked into the baby!! Yikes!!!

Lead placement is pretty much an anything goes kind of thing in my unit. As long as they pick up a heart rate, they will show us a brady or tachycardia or SVT. That's about all we would know how to interpret. In fact, once in awhile the monitor will alarm asystole or a deathly low brady but the QRS's aren't spread out so we know it's an artifact. Then we either move the leads around, or, if we don't want to wake the baby we unplug the black, white and green leads and plug them in differently. Then we get a slightly different-shaped QRS and it gives us an accurate number.

I admit, I'm a knot-tier! I hate when they're untied and going every which way! Yes, they are unpleasing to the eye (NICU nurses can be so anal)... but I HATE that they get all tangled in the other wires and lines and ALWAYS end up wrapped around and around little arms, legs, toes, etc... Then they get pulled off cause they're tangled around arms, etc etc