Medically Fit For Exams
Medically Fit For Exams

12 lead ECG placement

  • Wash your hands and introduce yourself
  • Check the patient’s name and DOB
  • Explain the procedure and gain consent
    • Explain that the patient will need to take their top off, and offer a chaperone
  • Ask if the patient knows why they are having the ECG

 

Prepare your equipment

  • ECG machine
  • 10 sticky pads
  • Wipes/razor

 

Lead placement

  • Ask the patient to undress and lie on the couch at about 45 degrees
  • Wipe or shave the areas to be used if overly hairy or covered in cream/ointment
  • Place 10 sticky labels as follows:
    • Right wrist
    • Left wrist
    • Left ankle
    • Right ankle
    • Right 4th intercostal space, edge of sternum
    • Left 4th intercostal space, edge of sternum
    • Left 5th intercostal space, mid clavicular line
    • Left 5th intercostal space, mid axillary line
    • Two in the gaps between the three above
    • NB - all leads should be pointing towards the umbilicus to reduce sticky pads peeling off
  • Untangle the leads, and affix as the diagram suggests
    • Use mnemonic 'Ride Your Green Bike' for limb leads
    • Red = Right wrist
    • Yellow = Left wrist
    • Green = Left ankle
    • Black = Right ankle
  • Place the lead bundle on the patient’s abdomen to prevent leads pulling
  • Ask the patient to lay as still as possible
  • Record the ECG and print out a copy
  • Look at the recording, if it isn’t acceptable, look at lead positions, or ask the patient to remain still while you record it again

 

Summary

  • Remove the leads, followed by the sticky labels
  • Tell the patient that they can get dressed
  • Ask the patient if they have any questions
  • Thank the patient for their time

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