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ECG Lead Placement and Identifying Lead Reversal, Schemes and Mind Maps of Medical Sciences

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

2021/2022

Uploaded on 09/12/2022

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ECG Lead Placement and
Identifying Lead Reversal
This quick reference guide is intended to show correct ECG electrode locations and
how to recognize inadvertent lead wire reversal.
Limb lead placement
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
Lead reversal
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
12-lead ECG: chest electrode locations
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 V4
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
12-lead ECG: additional chest electrode locations
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
12-lead: limb electrode locations
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
1 2 345 6
Lateral I mage
123 4 5 6
Right-Side Leads
5R 4R 313R 2 4 5 6
Posterior Leads
67 8 9
RA
R
LA
L
RL
N
LL
F
AHA leadwire labels in first column, IEC labels in second column
GDR 3323919_A
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ECG Lead Placement and

Identifying Lead Reversal

This quick reference guide is intended to show correct ECG electrode locations and how to recognize inadvertent lead wire reversal.

Limb lead placement

ƒ For accurate 12-lead measurements and interpretation, limb leads must be placed on the limbs, not the torso

ƒ For monitoring rhythm and rate, limb leads may be placed on the limbs or torso

Lead reversal

ƒ 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 ƒ Lead reversal usually produces recognizable ECG abnormalities

12-lead ECG: chest electrode locations

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

12-lead ECG: additional chest electrode locations

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

12-lead: limb electrode locations

ƒ Choose an ECG electrode site away from areas with a large amount of adipose tissue, major muscle groups or bony prominences ƒ 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

5R 4R 3R 1 2 3 4 5 6

Posterior Leads

RA

R

LA

L

RL

N

LL

F

AHA leadwire labels in first column, IEC labels in second column

GDR 3323919_A

©2015 Physio-Control, Inc., Redmond WA, USA.

Rhythm monitoring ECG: limb electrode locations

ƒ Limb leads may be placed on the torso (pictured) or limbs ƒ 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

LA RA lead reversal LA LL lead reversal

ƒ If there is P wave inversion in lead I, check for LA RA reversal

ƒ Also, if the other complexes in lead I appear inverted, check for LA RA reversal

ƒ If P waves or QRS complexes appear inverted in lead III, check for LA LL reversal ƒ However, be aware that physiologic left axis deviation can cause a negative QRS in lead III ƒ If P wave is larger in lead I than in lead II, check for LA LL reversal

RL lead reversals

Additional Tips ƒ 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

ƒ If the RL electrode has poor skin contact, ECG artifact may occur ƒ RL is used to minimize noise from common mode voltages, such as from power lines

ƒ If lead II has extremely low amplitude, check for RA RL reversal ƒ If lead III has extremely low amplitude, check for LA RL reversal

Chest electrode reversal (V1–V6)

Correct V leads

V1 V2 reversal

ƒ Normal R wave progression in leads V1–V

ƒ 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

ƒ Abnormal R wave progression in V1–V3 is due to V1 V2 reversal

RL

N

RA

R

LA

L

LL

F