EKG Lead Placement

[NICUnewbie]

I've been trying to find some information on the proper EKG lead placement for Neonates (using three leads)...there is an argument in our nursery about this and everyone places the lead in different positions...I was thinking about doing an in-service since this subject seems to be poorly understood by our nurses (myself included), but am having trouble finding info pertaining to preemies....

Thanks!

[MsJessikia]

do you ever see any of your nurses putting the red lead on the left thigh? I see it all the time at my hospital.

[Tiki_Torch]

A few thoughts:

1. I do not recommend using benzoin to get the leads to stick. Recently

an orientee did not ask their preceptor what to do to get the leads to

stick... He decided to use the benzoin. Our leads have the hydrogel

backs. In this case, the benzoin and the lead together on the baby's

right side of her chest caused an awful blister to occur which required

wound care for days and days. Either use some water or get a new

set of leads.... my humble opinion.

2. I also learned the "white on baby's right, black smoke rises above red

fire" and I still think about it sometimes when placing leads. Cool.

3. I remember learning somewhere that the leads will pick up best if they

are placed above the nipple line. I've found that the farther apart they

are seems to help too (placing them in the axillae). If the two top leads

are not perfectly across from each other they pick up better too... best

to have the black one up high and the white one a little lower so that

they are crossing the heart better (imagine an electrical impulse crossing

the heart in the chest). I've seen the red/green respiratory lead on the

leg or abdomen. It seems like the smaller babies monitors will pick up

ok with the leg lead but with the larger babies or the shallow breathers

it seems that the respirations pick up best if they are on the abdomen

below the black lead in a place where the abdomen rises and lowers

well enough for the lead to pick up the movement.

Tiki

[dawngloves, BSN, RN]

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

We hated the puppies! We'd change them once a shift because they'g fall off. Forget having them stay on a 24 weeker! We tried putting a little water on them and that did nothing.Kitties are somewhat better, but also a PITA.

[prmenrs, RN]

I think we gave up trying to put them on VLBWs for the 1st wk of life--took either the oxymeter pulse or a HR from the UAC. The respiratory therapists would put that capsule on their abds so the CPAP/SIMV apparatus could count the respirations. Plus, if they are on body humidity, those leads are never going to stick!

[KRVRN, BSN, RN]

I've found that when a baby is on humidity the leads (and temp probe stickers) become horribly SATURATED with water. Yeah, they stick "okay" but they just look so dang nasty you end up changing the anyway!

[KRVRN, BSN, RN]

Another thing, now many of you guys actually INTERPRET the EKG? Like read the strip and interpret something other than brady or tachycardia? I suppose you have to be more specific about lead placement then...

[prmenrs, RN]

Babies don't seem to have arrhythmias like grown-ups do. Most of the problems are from to much K+, too little Ca++, Digoxin issues, VSD repairs that took a stitch or 2 thru the conduction pathways, and an occassional, irritating SVT. If you think you see an arrhythmia, the docs will just say "get a 12 lead". So, lead placement for that purpose is a waste of time for babies. lol.

[Gompers, BSN, RN]

We hated the puppies! We'd change them once a shift because they'g fall off. Forget having them stay on a 24 weeker! We tried putting a little water on them and that did nothing.Kitties are somewhat better, but also a PITA.

We usually don't use them on 24 weekers. Generally we'll use the limb leads by the same brand on kids under 1000 grams, either on the limbs or we'll cut the tails off and use them like regular chest leads. They seem to stick better to those skinny little ribs - the PuppyDogs always seemed too stiff and wouldn't conform to those tiny angular chests.

To get hydrogel leads to stick on babies in high humidity environments, I've had luck cutting the tails off the limb leads and putting them on the baby's back in the same pattern as if they were on the chest. If the baby is laying on them, they seem to absorb less humidity than if they are more exposed to the air, plus the babies' backs are flatter than their fronts, so the leads seem to adhere more evenly. But if the baby is being positioned on the stomach, then I'll usually stick to chest placement, again to avoid that humid air.

[Gompers, BSN, RN]

Babies don't seem to have arrhythmias like grown-ups do. Most of the problems are from to much K+, too little Ca++, Digoxin issues, VSD repairs that took a stitch or 2 thru the conduction pathways, and an occassional, irritating SVT. If you think you see an arrhythmia, the docs will just say "get a 12 lead". So, lead placement for that purpose is a waste of time for babies. lol.

Exactly. We don't keep cardiac kids anymore, so if our kids look like they're having arrhythmias, it's usually an electrolyte problem. We'll also get a STAT EKG and in the 10-15 minutes it takes them to come do the test, we've already gotten a set of lytes on the kid and usually have found our problem.

[BittyBabyGrower, MSN, RN]

Same here, we don't use the 3 lead for diagnosis, unless it is SVT. We get the occas. PAC or PVC or block, but we hook up a 12 lead for that.

I love when they get the hiccups and at first glance it's like...dang, what was THAT! LOL!

[CarVsTree]

Wasn't a baby, but came into PCU one day and we must have had a float putting tele on (who didn't ask how). Anyone, I found all leads on the belly. On one patient, I found a lead in the groin (and no it wasn't moved by the pt). It was just weird.