Where should the LL limb lead electrode be placed for continuous bedside monitoring?
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What is this article about?In order to accurately and correctly assess a patient using 5-lead monitoring, it is necessary to understand how ECG works, know how to prepare the patient and follow the standardised system for electrodes and their placement. Learning you'll loveAn Ausmed Subscription will unlock access to 1,000+ learning resources. High quality education helps you provide high quality care. ContentsTest Your Knowledge
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Meet the educatorAusmed Editorial Team Ausmed’s editorial team is committed to providing high-quality, well-researched and reputable education to our users, free of any commercial bias or conflict of interest. All education produced by Ausmed is developed in consultation with healthcare professionals and undergoes a regular rigorous review process to ensure the relevancy of all healthcare information and updates to changes in practice. If you have identified an issue with the education offered by Ausmed or wish to submit feedback to Ausmed's editorial team, please email with your concerns. View Profile Here's some further inspirationPractice AreasAusmed PremiumTo access this resource, sign up for Ausmed Premium. With Premium, you’ll have unlimited access to everything you need to take your education and care to the next level. There are so many different subjects on Ausmed! I thought it'd be hard to find the resources I need for complicated procedures or rarer conditions, but they've had everything I've looked for so far. - Jacob, Enrolled Nurse Full Text Access for Subscribers:
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Institutional UsersAccess through Ovid® Not a Subscriber?Buy Subscribe Request Permissions You can read the full text of this article if you: Log In Access through Ovid PHOTO GUIDE POPE, BARBARA B. RN, CCRN, MSN Clinical Editor, Nursing2002
Nursing: April 2002 - Volume 32 - Issue 4 - p 50-52
What is ElectrocardiogramAs a non-invasive yet most valuable diagnostic tool, the 12-lead ECG records the heart's electrical activity as waveforms.When interpreted accurately, an ECG can detect and monitor a host of heart conditions - from arrhythmias to coronary heart disease to electrolyte imbalance. Since the first telecardiogram recorded in 1903, huge strides have been made in the recording and interpretation of ECG. Today, the 12-Lead ECG remains a standard diagnostic tool among paramedics, EMTs, and hospital staff. Contents
The 12-Lead ECGA 12-lead ECG paints a complete picture of the heart's electrical activity by recording information through 12 different perspectives. Think of it as 12 different points of view of an object woven together to create a cohesive story - the ECG interpretation. These 12 views are collected by placing electrodes or small, sticky patches on the chest (precordial), wrists, and ankles. These electrodes are connected to a machine that registers the heart's electrical activity. Who Should Have a 12-Lead ECGThe main purpose of the 12-lead ECG is to screen patients for possible cardiac ischemia. It helps EMS and hospital staff to quickly identify patients who have STEMI (ST elevation myocardial infarction or in other words, heart attack) and perform appropriate medical intervention based on initial readings. 12-Lead ECG Electrode PlacementTo measure the heart's electrical activity accurately, proper electrode placement is crucial. In a 12-lead ECG, there are 12 leads calculated using 10 electrodes. Chest (Precordial) Electrodes and Placement» V1 - Fourth intercostal space
on the right sternum Limb (Extremity) Electrodes and Placement» RA
(Right Arm) - Anywhere between the right shoulder and right elbow Additional notes on 12-lead ECG Placement:
The 12 Lead GroupsA lead is a glimpse of the electrical activity of the heart from a particular angle. Vertical plane (Frontal Leads):By using 4 limb electrodes, you get 6 frontal leads that provide information about the heart's vertical plane:
Leads I, II, and III require a negative and positive electrode (bipolarity) for monitoring. On the other hand, the augmented leads-aVR, aVL, and aVF-are unipolar and requires only a positive electrode for monitoring. Einthoven's TriangleThe Einthoven's triangle explains why there are 6 frontal leads when there are just 4 limb electrodes. The principle behind Einthoven's triangle describes how electrodes RA, LA and LL do not only record the electrical activity of the heart in relation to themselves through the aVR, aVL and aVF leads. They also correspond with each other to form leads I (RA to LA), II (RA to LL) and III (LL to LA). As a result, they form an equilateral triangle. Hence it's called the Einthoven's triangle, named after Willem Einthoven who invented the first practical ECG. Keep in mind that RL is neutral (also known as point zero where the electrical current is measured). RL doesn't come up in ECG readings, and is considered as a grounding lead that helps minimize ECG artifact. Horizontal Plane (Transverse Leads)By using 6 chest electrodes, you get 6 transverse leads that provide information about the heart's horizontal plane: V1, V2, V3, V4, V5, and V6. Like the augmented leads, the transverse leads are unipolar and requires only a positive electrode. The negative pole of all 6 leads is found at the center of the heart. This is calculated with the ECG. Patient Positioning for 12-Lead ECG Placement
How to Reduce Significant ArtifactA slight ECG artifact is not uncommon. However, you can reduce further interference through the following steps:
Skin Preparation
Electrode ApplicationExact placement of each electrode on the patient is important. Incorrect placement can lead to false or misleading diagnosis.
ECG VariationsApart from the standard 12-lead ECG, other variants include: 3-Lead ECG A 3-Lead ECG uses 3 electrodes that are labeled white, black, and red. These colors are not universal as two coloring standards exist for the ECG (discussed below). These 3 leads monitor rhythm monitoring but doesn't reveal sufficient information on ST elevation activity. 5-Lead ECG A 5-Lead ECG uses 4 limb leads and 1 chest lead. It helps improve ST elevation readings but it's still inferior to the 12-lead ECG. Color Coding Standards for the 12-Lead ECGCurrently, there are two color coding standards for 12-lead ECG:
If you're using AHA's system, use this mnemonic to easily recall limb electrode placement:
ECG Best Practices:
Where should the LL limb lead be placed for continuous bedside monitoring?Left arm electrode is placed in the fifth right intercostal space just to the right of the midclavicular line. The left leg electrode is placed in fifth right intercostal space in the mid clavicular line.
Where should ll leads be placed?Proper 12-Lead ECG Placement. Where are the three leads for continuous monitoring usually placed?Place LL (red) electrode on the lower left abdomen within the rib cage frame. Place RL (green) electrode on lower right abdomen within the rib cage frame. Place V1 (brown) chest lead in the fourth intercostal space, right sternal border. Place V2 (brown) chest lead in the fourth intercostal space, left sternal border.
What limb areas should you place electrodes?Leads are placed as shown: Right Arm (RA) over the manubrium; Left Arm (LA) over the xiphoid process; and Left Leg (LL) in the standard V4 position (5th ICS MCL).
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