Ekg Leads in all the wrong places

[wakyone]

Hello all,

I am new to this site, but not new to OR nursing. Been doing this since a little after the Beatles came to America!In the OR where I am working, the pre-op admission aide takes vitals and gets an EKG strip for the anesthesiologist. The lead placement has been determined by anesthesia, but does not take into account the type of surgery the patient is having. The leads are always wrong for shoulder cases, breast cases, etc. So in the OR we must change them. How do you handle this in your workplace?

[brownbook]

I've been away from cardiac nursing a long time. I do work in pre-op, PACU, sometimes help out in OR.

My limited knowledge, memory, is that a 3 lead ekg is only going to give you rate and rhythm. A 3 lead will show how fast the heart is beating, and would show some basic arrhythmias, PVC's, a-fib, a-flutter, blocks, etc.

A 12 lead EKG has very specific lead placements that cannot be altered. A 12 lead is going to show potential cardiac damage from a MI.

For the purpose of "routine" OR cases the 3 leads can be placed almost anywhere in the upper chest and back, as they often must be out of the way of the surgical site. Regardless of where they are placed they will still show electrical activity of the heart, the rate, rhythm, etc.

[drums326]

Our anesthesia providers place all of their leads themselves. Any preoperative EKG's are done in the clinic/wards during their initial preoperative phase. If there is a problem with how your pre-op people are doing things, why not walk over there and correct them directly or send an e-mail to their supervisors about the necessary changes that need to be made.

[SandraCVRN]

We just put new leads where we need them and remove the old one after intubation. If that is my biggeat problem of the day I'm a happy camper.

[Rntr]

Don't sweat the small stuff.... just move em..

[D0wnUnderRN]

We have anaesthetic nurses who place our ECG dots - as RNs these nurses are familiar with the required exposure neccessary for any given procedure (there is the odd occasion that one might have to be moved, but it's infreqent).

It's for little reasons like this that I am glad that most of Australia has not moved away from having RNs assisting the anaesthetist. We have enough to do in the OR without having to redo someone else's work.

[Argo]

Everywhere I have worked we roll the patient in the room, put all of our own monitors on which includes the 5 or 6 lead EKG. Whats the big deal with putting on these pads? Even on our hearts we put on our own leads(two different 6 leads and another 3 lead, total 15 pads)..... We have anesthesia techs around but I see them about once ever 4-5 cases...... I mean really, It is a matter of seconds.