Female Chest Examination & Ecg Lead Placement

**NICU Guy, BSN, RN** · Feb 16, 2017

The leads go into the same locations as the males. You (or patient) need to lift the breast in order to place the leads in the proper location.

Here is a thread on the subject

https://allnurses.com/male-nursing-student/ekg-on-female-282137.html

drbeckrn, NP · Feb 16, 2017

That thread deals mostly with how to be courteous when doing the procedure. I know where the locations are when the patient has a flat chest for ecg and cardiac aulsculation, but women with bigger breasts kind of displace where you would normally listen or place leads. Like the tricuspid location is 5th intercostal space on the left side but breasts tissue is raised there. Same with mitral location which is same area more left of the sternum near the Nipple. However, this area in the female can be greatly raised and displaced. Do you just put the stethoscope on top of the beast tissue in the general area or lift the breast? Same with Erbs point. For the leads does V3-V6 all go under the breast fold?

TheMuffinMan · Feb 17, 2017

What I typically do is use the gown, rolled or bunched up over the breasts (using bedsheets/blankets to keep the perineum area covered) to keep them covered and then can either go in from the neck opening or up from the bottom. If the woman is younger then 30 or older then 60 I almost always try to have a female coworker (doesn't have to be a nurse) in the room as well when doing anything that the patient could misunderstand, or take offense to. In those higher-risk situations I always am verbose in what I'm doing and why, before I do it.

For ekg leads I place them as close as I can to where they need to go and then check with tele to find out if they're getting a good reading. If not I adjust the pad that seems the most out of place and usually it only takes me 1 adjustment to get the placement correct.

barcode120x, RN, NP · Feb 25, 2017

drbeckrn said:
That thread deals mostly with how to be courteous when doing the procedure. I know where the locations are when the patient has a flat chest for ecg and cardiac aulsculation, but women with bigger breasts kind of displace where you would normally listen or place leads. Like the tricuspid location is 5th intercostal space on the left side but breasts tissue is raised there. Same with mitral location which is same area more left of the sternum near the Nipple. However, this area in the female can be greatly raised and displaced. Do you just put the stethoscope on top of the beast tissue in the general area or lift the breast? Same with Erbs point. For the leads does V3-V6 all go under the breast fold?

Fyi, lead placement and listening to breath and/or heart sounds are not a test. You do not have to get them down exactly one the first go. Regardless of breast tissue (unless its an enormous amount), the leads can be placed in the usual area and it should still read pretty well on the monitor. In regards to listening for heart sounds, I guess just move around? Simple as that. As you have already noted, every person has a different anatomy so there is no exact spot for everything. Just move your stethoscope around :nurse:

tonsonmicle · May 30, 2018

Learn about correct ECG placement Female on this video:

Medic_Murse, BSN, RN, EMT-P · May 31, 2018

"Larger breast tissue", God I love newbies! I'm going to tell you two things....

1. You would listen for heart/breath sounds on a woman with "Larger breast tissue" as you would anyone else. Same goes for EKG leads.

2. I'm going to tell you what my Paramedic instructor told me back in the day. Don't be shy, get in there! Trust me, there are those you may need a waist belt, to help support your back as you try to get it out of the way!

neuron · Jun 2, 2018

Not only a woman with large breasts but an obese woman with large breasts. How do you auscultate all of anterior thorax?

DannyBoy8, RN · Jun 7, 2018

Medic_Murse said:
2. I'm going to tell you what my Paramedic instructor told me back in the day. Don't be shy, get in there! Trust me, there are those you may need a waist belt, to help support your back as you try to get it out of the way!

Don't be shy.....but make sure you have consent from the patient - if they're responsive.

TheDudeWithTheBigDog, ADN, RN · Jun 18, 2018

Let's solve the ECG question really easy:

For a 5 lead: The real-life training for this at jobs is seriously just being shown the diagram on whatever the leads are plugging into, or a 10 second explanation of left vs right in a class on reading ECGs. That's how un-exact of a science the placement is. If a breast is in the way, just go lower, or to the side, or both. You don't want it resting on that for a long time, it's going to get uncomfortable, so you're going to put it somewhere that's not under a breast anyway. It's going to read exactly the same on the monitor as long as you have left and right correct, and arm on top and leg on bottom.

For a 12 lead: Just tell them you have to put the leads under their breast. Then either have them lift it, or stick the back of your hand under there and lift (both can be done while keeping them still covered). Can't be shy in healthcare. If you can wipe an ass, you can lift, see, or touch a breast.

The trick to working with female patients is simple: Just like with a mail patient, just tell them what you need to do before you do it. Most things, you can keep them covered. And for things that you have to uncover them, most people are ok with it as long as you communicate. Don't just pull a gown off, tell them what you have to do first. Just basic personal respect. Almost every female patient you ever interact with is going to be exactly the same with you being a male as they would if you were a female.

Crash_Cart · Jul 15, 2019

No magic tricks here.

Just communicate your intentions in advance and be respectful of maintaining privacy.

You are after all a professional right? If you portray and conduct yourself in a purely clinical kind of way, they will interpret what you are doing in the same exact way.

Brian A · Jan 24, 2020

Above or below? It is not about the breasts it is about the intercostal spaces. With research and asking 12 lead experts like Bob Page, here is the best answer I have heard. In most women, you cannot palpate the 5th ICS, mid-clavicular line because of the amount of breast tissue. In that case the leads go below the breast. However, there are those cases with larger breasts, that have moved south over time, where you can clearly palpate the location of V4. In those cases then the leads go above the breast and on the correct intercostal spaces. "It is bones not breasts".