EKG Lead Placement

KRVRN, BSN, RN · Dec 31, 2004

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

Mithrah · Jan 1, 2005

I was taught not to put the lead over the nipple. Otherwise anywhere goes as long as white is on right, black on left, and green near the hip or thigh. I also hate it when they are tied into a knot. But I also hate when they get the wires tangled around their toes and they pull it off.

How do you get the leads to stick better? Besides getting new ones or getting them wet?

prmenrs, RN · Jan 1, 2005

I agree, not on the nipple!!! The problem w/knot-tying is that it breaks the tiny wires inside the wire, or at least that is what one of the company reps explained to me. They said the wires were like fiberoptic cables, and can be broken if you knot them. So that makes them not work as well. I will allow that it is neater and less of a hassle, but....

No tricks here about getting them to stick. I think staple guns are out of the question (just kidding, honest), but the thought has crossed my mind. Wet 'em, try again, wash off the skin again, swearing...

TiffyRN, BSN, PhD · Jan 1, 2005

I was a cardiac nurse a while ago and we had the same basic set-up I've heard described above (white on right. . .). Then we got new monitors made by some sadistic person and none of those colors were where they had been in the past and there were five leads to attach (supposedly so we could run 12lead EKGs from the tele monitors but they never showed us how so oh well). Thankfully there was a diagram on the tele box showing where to attach each color, as well as a brief description at the base of the leads on the tele box (LL for left leg, RA for right arm and so on)

As for getting them to stick. . . We USED to have great leads, a brand called "spacelabs" but of course that had to change probably because they cost about 1/2 cent more a pack than the new ones we have now. We now have some kind made by 3M. The old spacelabs not only stuck better the lead wires were a little longer and we didn't know this was a plus until we switched over and it seemed the new ones were just the wrong length, they were always catching on the edge of the open cribs where the leads attached to the cable, not as big a deal in the isolettes or RW's. We actually had quite a few spacelabs stashed away we used for the big sweaty kids. Spacelabs were also great in that if they got ripped off accidently they would actually restick without rewetting (and do the 3M's really stick all that well after rewetting? Not in our experience, just long enough to get your monitor to shut up until you find a new set of leads). So one has to wonder how much is it really saving the hospital when we rarely went through more than one set of Spacelabs before the mandatory change time (every 3 days with baths) compared to the new 3M's that have to be replaced frequently because they just won't stick anymore (some kids go through a set each shift).

dawngloves, BSN, RN · Jan 2, 2005

No tricks here about getting them to stick. I think staple guns are out of the question (just kidding, honest), but the thought has crossed my mind. Wet 'em, try again, wash off the skin again, swearing...

How about glue? Serious! When I did adults we would use benzoine on the sweaty ones. Could we use it on the kiddos?

prmenrs, RN · Jan 2, 2005

I'd worry about toxicity--their skin is so permeable, even after the first few days.

BittyBabyGrower, MSN, RN · Jan 2, 2005

We don't use Benzoin with our leads because of what premnrs said, but we will us skin prep towels. We also use these with our ostomy bags :)

KRVRN, BSN, RN · Jan 2, 2005

Sometimes swiping the lead with an alcohol pad will get it to re-stick... SOMETIMES. It only works if they are not sticking because they have body oil and debris on them (of course if they're that funky they ought to be replaced anyway...). I usually try to place them in the armpits because then their arms hold them on better than if they are on their chest. Then again, sometimes having our leads in a perfect horizontal line from each other (like if they're in the two armpits), the monitor alarms asystole and they needing repositioning anyway.

For our micros we have a small stash of limb leads that have a smaller adhesive pad and a 2 inch or so long cloth (paper?) tail coming off of it with a sticky part at the end. So the lead is placed on the upper arm or thigh and then the tail is wrapped around the limb and stuck down. Really convenient for frequent CXR's (which we have to remove leads for). You don't get an accurate RR value, but we never trust it anyway.

Is 3M the company that makes the kitty cat leads? They're black, white and green. That's what we have. One time we trialed the same company's puppy dog leads and man, they stuck to everything... even the fresh vernix-y 33 week admits. And supposedly we could xray through them too, I don't know why they didn't get those for us.

BittyBabyGrower, MSN, RN · Jan 3, 2005

I love the limb leads! We will even cut the tail off and us the sticky part as regular chest leads on the itty bitt. A lot of the time, we put them on the arms and cut the one for the belly. Much better resps!

I hate the kitty cat ones...they dry out so fast and they don't stick that great! We had others that were great...they had a more gel like back and they stuck so much better! Cost, cost, cost!

Gompers, BSN, RN · Jan 3, 2005

I love the limb leads! We will even cut the tail off and us the sticky part as regular chest leads on the itty bitt. A lot of the time, we put them on the arms and cut the one for the belly. Much better resps!
I hate the kitty cat ones...they dry out so fast and they don't stick that great! We had others that were great...they had a more gel like back and they stuck so much better! Cost, cost, cost!

I do the same thing with the limb leads! One on each arm and one on the side of the belly for resps - doesn't cause problems with the X-ray there.

We switched our Kitty Cats for Puppy Dogs a few years back. The cost really isn't too much different, I believe. The big difference is that the Puppy Dogs don't show up on X-ray, and the hydrogel adheisive is much more durable, so you are able to resite them daily and get more use out of them. I believe the Puppies and Kitties, as well as the limb leads, are all made by Argyle.

KRVRN, BSN, RN · Jan 4, 2005

I looked today. They're made by Kendall.

Gompers, BSN, RN · Jan 4, 2005

Oh no! I checked their website, and unless I'm blind, they no longer list Puppy Dog leads! Only the Kitty Cats, limb leads, and these new ones called "Noah" which are radiolucent limb/back leads. I hope they haven't stopped making those Dogs!!!

http://www.kendall-ltp.com/neon01.htm