Where to Place Telemetry Leads?

[Navarre]

Hi! I'll be starting as a nurse intern on a med-surg floor and I know a lot of the patients are on tele monitors. Can anyone please tell me the location on the pt's chest where you would place the 5 leads? and how often do you have to change the stickers? Thanks!

[veronica butterfly, ADN, RN]

I learned this "mantra" when I was a nursing assistant. If you have 5 leads for a tele, go....

White right

Snow over grass

Brown ground

Smoke over fire

Start with White--right. Get it?, it rhymes... white right right side of the chest. I put it about the second intercostal space under the clavicle in that spot where there's no bone.

Then green below that because SNOW OVER GRASS, white over green. Straight below the white sticky kind of at the bottom of the rib cage.

Brown is ground, smack in the middle of the chest. just at the bottom of the sternum.

then Black over red because SMOKE OVER FIRE. Since you've already got leads on the right side, the black and red have to go on the left, it's what you've got left. Put them in the same positions as the leads on the right side.

There probably is an exact textbook way to do this, but as long as the tele monitor is picking up a good waveform, you've got them placed good enough.

You don't have to change them on a regular basis, the less removing and replacing the better for the patient's skin. Sometimes folks are diaphoretic and they fall off from the moisture.

Also, if someone's got a hairy chest, you'll want to shave the hair off before putting the stickers down. Saves them some pain on removal and you'll pick up the waveform better when the stickies are right on the skin.

Also, also.... put the leads onto the stickers BEFORE you put them on the patient's chest. Sometimes you have to press pretty hard to get them attached depending on the brand, and it hurts people when you're pressing with one finger down into that sticker on their chest.

HAVE FUN!!

[rnccm, RN]

I learned a more crude one, Starts out white on the right with clouds (white) over grass (green). The doggie "goes" in the middle (brown), and smoke (black) over fire (red),

[youngatheart]

Thanks for the helpful tool to remember. It helps me.

[Navarre]

Thanks for the great advice! That helps decrease my anxiety a little.

[meownsmile, BSN, RN]

And if that doesnt work,, you can usually flip that little tele box over and it will show you where to place which lead. Most of them have little lights that will cycle through when they are placed right and just around the little lights are color coded rings on a figure of a chest. If you have a light on it isnt making contact. Most tele monitors are like that anyway. Check both sides of the tele transmitter.

[msn2008, MSN, RN]

You will also want to check which leads your hospital monitors their tele patients in. I believe it is standard practice to monitor in V-1, which places the brown lead in the 4th intercostal space, right sternal border. The red lead can be a lead 111, which would put it on the left side of the patient's upper abdomen/lower rib cage, OR , a modified v-6 which puts it at the 5th intercostal space, mid axillary line. These two leads pick up more accurately ectopies,bundle branch blocks, and are also used for st segment monitoring in critical care units and telemetry floors. Be sure to ask what your hospital's policy is, and if they don't have a written one, someone needs to do the literature review and establish best practice standards. Good luck!

Melissa

[rnmi2004]

I second meownsmile's post. The tele boxes will tell you where to put the leads.

[MAnders1405]

I learned White - Right, Red Ribbs, Smoke over fire (black over red), clouds over grass (white over green) and brown in the middle.

[ashfost, BSN, RN]

Hehe. I like "SALT (white/ upper right), PEPPER (black/upper left), HAMBURGER (brown/middle), LETTUCE (green, lower right), TOMATO (red/ lower left)!" I wondered why I would always get hungry when putting on leads!

[loveslife]

You DO have to remove and change the electrodes every 24 to 48 hours. You need to check the patients skin for irritation and allergic reactions. Then when you reapply the electrode put them in a slightly different place as before.