Question about Telemetry

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I have a question about telemetry. I work on a floor that has some patients on monitors. And I'm a little confused about where to place the leads. I always thought the 2 top leads were placed on the upper chest about in the middle -lined up with the nipples somewhat. Then I thought the middle lead was placed right below the sternum. And then the bottom 2 leads were placed right below the rib cage.

But then I was reading in my critical care nursing book and it says this:

Limb leads are placed on the body close to where the limbs join the torso. The right and left arm leads are placed at the shoulder where the arms join the body. The right and left leg leads are placed on the lower abdomen closer to where the legs join the torso below the umbilicus. The chest lead can be placed to monitor any of the V leads. (When they say chest lead I'm asuming they are referring to the middle lead that is between the chest and abdomen.)

So according to this, I have been doing it wrong all along. I've been putting hte leads to close together. It seems like most people do this. I've had patients come up from the ER with leads already on and they are very spread apart - in the correct way in which the book states, and I've always moved them because I thought they were too far apart.

So if someone could help me figure out the correct placement it would be greatly appreciated!!!

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Specializes in SICU.

The ER has it correct. With your 5 lead you can with moving the chest lead around get a 12-lead EKG view of the heart. With a true 12 -lead the limb leads are placed on the actual limbs and the pt has to remain still. You can't ask a pt to remain still for the entire time tele is on them so the limb leads are moved to the torso (stable, less movement) but close to the limbs they should be on. The chest lead can be moved around in order to see the different V leads I to VI. Most have it looking at V1.

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So basically the textbook and Er are correct?

I've just been following how the other nurses on the floor have been doing it. And the middle lead (V lead) can be place anywhere on the sternum?

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Specializes in Cardiac Telemetry, ED.

You need to ask your clinical educator or look in the manual for your specific telemetry device. Our unit uses a system in which the correct setup is one lead at the top of the sternum, one at the bottom, one lead on the left lateral side at the fifth intercostal space, one lead on the right lateral side at the fifth intercostal space, and the last lead on the RUQ just under the rib cage.

Sometimes when a patient is admitted through the ED and was transported to us on a portable monitor, the person who tucks them in will just put our tele leads on the preexisting electrode patches, which are in a different configuration. I have to go back into the room and redo them because the different positioning causes interference and we don't get a clean signal.

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Specializes in CTICU, Interventional Cardiology, CCU.

we have color coded leads, but when I am transporting there are only 3 color leads. But basic telepacks in my floor I know black is upper-to mid sternum above the breast midclavicular line, brown is lower sternum, directly below the black lead mid clavicular below the breast, red is left below the breast left side, green is right side below the breast or upper part of the abd depending on how much the pt. weighs, and white is right upper clavical near the sholder. and transport monitor is black lead(same as stated before), brown lead (same as stated before) and red (same as stated before) although sometimes the brown is white but I know as long as the black and red are placed correct I can place the 3rd. lead. I know I sound like a 4 y.o. with the colors and most tele packs have illustrations on them that you can follow. BUT When all else fails I think where would I put a 12 lead with no colors. And I ALWAYS have my pocket guide to help, esp. working on a Interventional cardiology floor and always have your 12 lead memorized and practice if you can.

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Another quick way to remember what color goes where.

White... Right ( this is the lead that goes on the right upper clavicle area ).

Black is opposite of white. (so this lead goes on the left upper clavicle area).

Smoke (or black ) over fire (or red ). So the red lead goes on the left lower rib cage or torso area.

Green is grass or ground ( and the only lower place left is on the right lower abdomen ).

Brown is the only lead left, and the V lead. In our facility we put the V lead in the 4th intercostal space on the right as you are facing the patient.

In summary: Right white, black opposite of white, smoke over fire, green grass, and then brown is what is left over.

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Wow I never learned that way of thinking about it But I will now forever remember what goes where LOL

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Specializes in Cardiac Telemetry/PCU, SNF.
Wow I never learned that way of thinking about it But I will now forever remember what goes where LOL

After placing leads on literally hundreds of time, you can do it in your sleep.

Here's how I remember, and teach new folks:

smoke over fire (black over red)

sky over forest (white over green)

with a chocolate center (brown lead)

Our center lead is the same as Lead I in a 12-lead, lateral of the sternum at the 3 interconstal. Everything else matches what y'all are saying.

Cheers,

Tom

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Specializes in ER, PCU, ICU.

As far as placement is concerned, try not to put the red and green leads over bones such has the clavicle, acromion or coracoid processes. Likewise for the black and white patches being over the iliac crest or rib cage. Signals are degraded when the patches are over bone. With trauma, I've even put the limb leads on the pt's back.

As for the V lead, it SHOULD be able to be placed anywhere the precordial leads would go in a 12 lead EKG and it's prudent to consider placing it where it'll do the most good. For example, if a pt is admitted with an MI showing an infarct on leads V4 and V5 on the 12 lead, I'd probably put the V monitoring lead on V3 or V6 just to watch for any extension of the infarct. Placing it adjacent to where there's a problem helps you watch for any changes.

If the pt is hemodynamically stable, then V1 is usually where I put it.

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Specializes in Interventional Radiology.
Quote

I have a question about telemetry. I work on a floor that has some patients on monitors. And I'm a little confused about where to place the leads. I always thought the 2 top leads were placed on the upper chest about in the middle -lined up with the nipples somewhat. Then I thought the middle lead was placed right below the sternum. And then the bottom 2 leads were placed right below the rib cage.

Dear luv2shop

Rib CageThis should be your lead placement for tele monitors with 6 leads. The middle leads can be moved to get around incisions, chest tubes, excessive hair (though this should be shaved)- but try to stay for your VA lead as close to the right 4th intercostal space as possible, and for Vb as close to the 4th IC at mid axillary for the best visiblity on the monitor. Be careful with older skinny people placing the limb leads too low...all you'll see is artifact! Hope this helps.

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Specializes in med surg.

i was taught to feel for my landmarks and not just stick a lead in the general area. This is difficulty sometime depending on the type of surg and where the dressings is.

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Specializes in tele, stepdown/PCU, med/surg.

so the middle lead is the V lead and not ground?

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