Need Help Figuring this Out- 5 Lead Tele

[TheGerb, MSN]

Hi! My mind is really blown by something that I'm sure has a simple answer that another RN would know right away. Looking for some answers.

Last night I had a patient on a 5-lead tele monitor and I kept getting an error that the LL (left leg/red) lead was not connected. II tracing looked beautiful, but at no point could I get V to show up d/t LL not connected error. These are the things I tried:

• replaced the electrodes, wiping down the site with alcohol before placement. No hair on site, great stick.
• Double check wire connection: looked great. 
• Moved position of the electrodes 5-6 times trying to find a best spot
• Changed box, changed wires

Pt had a recent pacemaker placed and severe ascites. Was told by tele techs that neither of those would impact like this and that is was definitely end user error. I've been a tele RN for 6 yrs. Haven't had this issue before. Thanks!

[nursej22, MSN, RN]

I  would guess that you had a faulty set of wires, or a faulty tele box. I would have tried hooking it up to someone else or yourself to see if you could recreate the issue.

Things wear out or just break. 

[TheGerb, MSN]

1 hour ago, nursej22 said:

I  would guess that you had a faulty set of wires, or a faulty tele box. I would have tried hooking it up to someone else or yourself to see if you could recreate the issue.

Things wear out or just break. 

That's definitely true. I tried two sets of wires and two different boxes though (and interchanged them) and they were a nicer 1yo Phillips model. I joked with the patient that my next step was going to be to change the patient so the machine would work. ?

[NightNerd, MSN, RN]

Literally was just told this last night, but supposedly alcohol will decrease conductivity? Was told to use either soap and water to cleanse, or just a dry pillowcase, gown, etc. before placing leads.

[nursej22, MSN, RN]

We always told by the manufacturer reps that cleansing with soap and water, then allowing to dry was best. You likely use disposable leads, but the reusable ones get gunky and need a good scrubbing from time to time. 

[TheGerb, MSN]

2 hours ago, nursej22 said:

We always told by the manufacturer reps that cleansing with soap and water, then allowing to dry was best. You likely use disposable leads, but the reusable ones get gunky and need a good scrubbing from time to time. 

Oh that's good to know. Always love learning new little tidbits. I was using disposable leads. At tried fresh leads on: dry skin not cleaned, skin rubbed lightly with gotten, and then skin cleaned with alcohol wipes. No reading on any of them.