ECG Electrode Placement

Performance Evaluation
Name: Course/Group No.:
Date Covered: Area:

Instruction: Give the appropriate rating for each item based on the given numerical rating.
Numerical Rating Quantitative Description
Consistently displays behavior even without guidance and
5 Outstanding
supervision
Carries out expected behavior with minimal guidance and
4 Very Satisfactory
supervision
Exhibits behavior in a moderately consistent manner with
3 Satisfactory
frequent guidance and supervision
Needs Carries out expected behavior with close guidance and
2
Improvement supervision
Doesn’t carry out expected behavior even under close
1 Unsatisfactory
guidance and supervision

NURSING SKILLS 5 4 3 2 1
Prepare complete ECG set; ECG machine with recording
1 paper, electrodes, conduction gel
Optional: clippers, alcohol swab
2 Verify the written prescription for obtaining ECG
Explain the procedure to reassure the patient and significant
others. Observe the 10 Rs.
3 Explain that the test may be repeated several times when
necessary. Emphasize that no electrical current will enter the
body.
4 Provide privacy.
5 Do hand hygiene before and after the procedure.
Instruct the client to lie supine in the center of the bed with
arms at the side. You may raise the head of the bed to
6
promote comfort. Make sure the feet are not touching the
bed board.
Expose the arms and the legs and cover the client
appropriately. The arms and legs should be relaxed, to
7
minimize muscle trembling, which can cause electrical
interference.
Select flat, fleshy areas to place the limb lead electrodes.
8 Avoid muscular and bony areas. If the client has an
amputated limb, choose a site on the stump.
If an area is excessively hairy, clip it. Clean excess oil or
9 other substances from the skin with alcohol pad to enhance
electrode contact.
 Apply disposable electrodes to the client’s wrists and to the
10
medial aspects of the ankles.
Expose the client’s chest. Put a pre-gelled electrode at each
electrode position. If your client is a woman, be sure to place
11 the chest electrodes below the breast tissue. In a large
breasted woman, you may need to displace the breast tissue
laterally.
Limb lead placement:
 Connect the lead wires to the electrodes. The tip of
each lead wire is lettered and color coded for easy
identification.
12
 The red or RA lead wire goes to the right arm.
 The yellow or LA lead wire goes to the left arm.
 The black or N/RL lead wire goes to the right leg.
 The green or LL lead wire goes to the left leg.
Chest lead placement.
 V1 red lead- 4th ICS to the right of the sternum
 V2 yellow lead- 4th ICS to the left of the sternum
 V3 green lead- midway between V2 and V4
13  V4 brown lead- 5th ICS at the midclavicular line
 V5 black lead- anterior axillary line at the same level
as V4
 V6 violet lead- midaxillary line at the same level as V4
and V5
Begin the ECG recording. Ask the patient to lie still and not
14
to talk breath normally and relax when recording ECG.
When the machine finishes recording the 12 lead ECG,
15
remove the electrodes and clean the client’s skin.
After disconnecting the lead wires from the electrodes, clean
16 and dry the electrodes according to manufacturer’s
instruction.
Assist the client to a comfortable position. Ensure that the
17
bed is in a low position.
18 Remove any remaining equipment and wash your hands.
Label ECG recording with:
 Patient’s name
 Medical record no.
19  Date
 Time
 Signature
Document the procedure in the nurses’ notes.
 Formula For Grading:
Total Score
---------------- X 50 + 50
Perfect Score
Student’s Signature

Clinical Instructor