Landmarks of 5- and 12-lead ECG Placement (Nursing)

00:01 So let's talk about the colors.

00:03 Each one of the electrodes attaches to a little snap on the chest.

00:08 So the stickers have a little snap, and then you have an electrode that you just pop onto that, and that's how they connect.

00:14 Now, this is a tale as old as time, because what you're saying here, this is the picture you see where we put the leads and this is how most people start.

00:22 You think white on the right, the right arm lead is usually white and it goes on the right. On the left arm lead, we say smoke over fire.

00:35 The left arm lead is black.

00:36 And you see the lower leg.

00:38 The left lower leg is fire.

00:40 It's red. So white on the right.

00:44 That's the. Right arm.

00:46 Leg. Good. Move over to the left arm.

00:49 Lead. That is black.

00:50 And it's smoke over fire.

00:53 Good. That's the lower leg.

00:55 Left leg lead.

00:56 Now we have two more because remember, we said we had a five lead and a five lead has legit five leads that have to be on the patient.

01:04 So you've got right arm right over, right, left arm, smoke over fire, which is the red one on the left leg.

01:13 The other two leads are green and the V lead now, the V lead goes kind of in the middle.

01:19 And you'll see in our picture, sometimes people think, okay, V lead.

01:22 I'm going to remember that because that's kind of where poop comes from in your tummy.

01:26 And there you go. So you can use that or not.

01:29 Just know the V lead is going to go in the middle.

01:32 And then lastly, that right leg, lean green goes last.

01:36 Okay. So the right leg lead goes over on that right side.

01:40 It'll be directly across from the left lower lead.

01:43 So that's it. That is a five-lead configuration.

01:47 You have the colors and where they go.

01:49 Now we know where the leads go.

01:52 And I want you to understand why it matters.

01:55 When we switch leads, we can look at lead one or lead two.

01:59 Those little electrodes are sending information back over to the machine in a very specific order.

02:06 So think if I'm looking from the right arm lead down to the left arm lead, I'm going to have one view of the client's heart or electrical activity.

02:15 Remember, electrical activity moves through the heart from the SA node.

02:19 Av node, right. All the way down through the heart.

02:22 So electrical activity is moving down this way.

02:25 So it's coming from all different angles when we have these different leads.

02:30 So let's see if that makes sense.

02:32 Just draw a quick picture of a heart, put on your essay, note your AV node, and then all the way down into your bundle of his right.

02:38 Teach your brain that the electrical signal is moving from the top down to the bottom in a healthy heart as that signal is moving down, using these five leads, different combinations of them helps us see different aspects of the electrical conductivity.

02:54 So there you see the five leads on your screen right there, all in the chest wall there in the right order. There's one more thing I want to tell you about.

03:03 Make sure that that cable is not all tangled.

03:06 The goal here is not to create macrame.

03:09 You want to make sure those lines are free and clear.

03:12 They're not tangled and they're not going to be in the way where someone could trip on them or pull them out. So I know that's common sense, but I just want to mention it because sometimes it can get all wadded up and knotted up and that's not good for anyone or anybody. Now that's the five leads, and they're all where? Chest wall. Right now, we're going to talk about the super fancy one, the 12 leads.

03:34 Okay. We talked before that in a five lead, we're going to see different angles and get really good pictures of how that electrical current is moving through the heart.

03:45 Remember, from the node to the AV node all the way down through the heart.

03:48 And by looking from different angles, we get different views or perspectives.

03:53 That's a five lead, but on a 12 lead we're going to get an even better picture of what's going on. Now here's the part you might find confusing when you go to actually put on a 12 lead. You only put on ten leads.

04:07 But from those ten leads, we can get 12 different views.

04:11 Okay. So don't be confused.

04:12 If you get something and you see only ten leads, don't think you've got like a broken kit. It's appropriate.

04:18 Ten actual snaps and electrodes will give us the ability to have 12 different views of the heart, and that's why we call it a 12 lead.

04:27 So on a five lead, all on the chest wall, on a 12 lead, you're going to have leads on their limbs and their chest wall.

04:35 So we're in a five lead.

04:37 You put the right arm under the right clavicle.

04:40 This time you're going to actually put it on the arm.

04:42 So the right arm lead goes on, the right forearm or the wrist.

04:46 The left arm lead goes on the left forearm or the wrist.

04:51 So they're not on the chest wall anymore.

04:52 They've moved out to the limbs.

04:54 Same things with the legs.

04:55 The left lower leg is that's where the left lower leg lead goes and it's proximal to the ankle. Same thing on the right lower leg.

05:04 It's also proximal to the angle.

05:07 So instead of having these on the chest wall, we've put them on your arms and on your legs.

05:12 Now what's left are the V leads.

05:15 You've got one, two, three, four, five and six.

05:18 That gives us our total of ten leads that give us 12 views of the heart.

05:23 And that's why we call it a 12 lead.

05:25 So V1, that's going to be in the fourth intercostal space on the right Sternal Edge V2, the fourth intercostal space on the left Sternal edge right V3.

05:36 We want it midway between V2 and V4.

05:40 Now V4 is going to be the fifth intercostal space in the midclavicular line.

05:46 V5 the anterior axillary line in a straight line with v4 and finally v6 is the mid axillary line in a straight line with v4 and V5.

05:58 Now this sounds far more complicated than it is, so take some time.

06:03 Look at the drawings, practice with a human and this will make perfect sense to you.

06:08 But you just need to practice it to teach your brain how to do it.

06:12 And all 12 league machines come with exact pictures like this.

06:16 So it's another reminder for you if you have to do it.

06:18 So we're wrapping this up.

06:20 This is kind of a basic guide of how to get started with putting on electrodes for either five lead or 12 lead monitoring.

06:28 Now, keep in mind, each institution might have a little bit of a different protocol and how often and who needs to be monitored.

06:34 But it's important that you keep up to date with each individual place of healthcare's specific policies.

06:41 So remember, it's our role.

06:43 No matter where we are, to make sure that the monitoring that we're using to make significant healthcare decisions is on accurately and thoroughly and gives us the best images possible.