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This quick reference guide is intended to show correct ECG electrode locations and how to recognize inadvertent lead wire reversal. Limb lead placement.
Typology: Schemes and Mind Maps
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This quick reference guide is intended to show correct ECG electrode locations and how to recognize inadvertent lead wire reversal.
For accurate 12-lead measurements and interpretation, limb leads must be placed on the limbs, not the torso
For monitoring rhythm and rate, limb leads may be placed on the limbs or torso
Ensuring that the ECG leads are connected to the correct ECG electrode position is very important for acquiring accurate rhythm strips and 12-lead ECGs Lead reversal usually produces recognizable ECG abnormalities
Electrode Location V1 C1 4th intercostal space at right border of the sternum V2 C2 4th intercostal space at left border of the sternum V3 C3 Midway between V2 and V V4 C4 5th intercostal space at midclavicular line V5 C5 Level with V4 at left anterior axillary line V6 C6 Level with V4-V5 at left midaxillary line
Note: automated interpretation may be invalid if V leads are moved to these locations
Electrode Location V3R C3R Midway between V1 and V4R V4R C4R 5th intercostal space, right midclavicular line V5R C5R Level with V4R at right anterior axillary line V7 C7 Level with V4-V6 at left posterior axillary line V8 C8 Level with V4-V6 at left midscapular line V9 C9 Level with V4-V6 at left spinal border
Choose an ECG electrode site away from areas with a large amount of adipose tissue, major muscle groups or bony prominences Limb electrodes can be placed any- where on the arms distal to the axillary fold, and anywhere on the legs
Electrode Standard Location RA R Right arm, near the wrist LA L Left arm, near the wrist RL N Right leg, above the right ankle LL F Left leg, above the left ankle
Frontal Image
Lateral Image
Right-Side Leads
Posterior Leads
AHA leadwire labels in first column, IEC labels in second column
GDR 3323919_A
©2015 Physio-Control, Inc., Redmond WA, USA.
Limb leads may be placed on the torso (pictured) or limbs Choose an ECG electrode site away from areas with a large amount of adipose tissue, major muscle groups or bony prominences
Electrode Torso Location (limb location also acceptable) RA R Middle to outside end of the right clavicle, close to the bone LA L Middle to outside end of the left clavicle, close to the bone RL N Lower right trunk, just above the hip LL F Lower left trunk, just above the hip
If there is P wave inversion in lead I, check for LA RA reversal
Also, if the other complexes in lead I appear inverted, check for LA RA reversal
If P waves or QRS complexes appear inverted in lead III, check for LA LL reversal However, be aware that physiologic left axis deviation can cause a negative QRS in lead III If P wave is larger in lead I than in lead II, check for LA LL reversal
Additional Tips LL RL reversal has almost no effect on the ECG; you cannot identify it from the ECG, and it has little effect on ECG interpretation
If the RL electrode has poor skin contact, ECG artifact may occur RL is used to minimize noise from common mode voltages, such as from power lines
If lead II has extremely low amplitude, check for RA RL reversal If lead III has extremely low amplitude, check for LA RL reversal
Correct V leads
V1 V2 reversal
Normal R wave progression in leads V1–V
In a normal ECG, R wave amplitude should begin small in V1, then gradually increase through about V4, then decrease, however loss of R wave amplitude can occur due to an established myocardial infarction or other abnormality
Abnormal R wave progression in V1–V3 is due to V1 V2 reversal