12-Lead EKG Lead Placement Guide

Introduction

• Video demonstration by Sarah of lead placement for a 12-lead EKG.

Supplies Needed

• 10 electrode stickers
• Alcohol prep wipes
• Abrasive tape (fine gritty sandpaper)
• Trimmers (for patients with chest hair)

Preparation Steps

1. Electrode Stickers: Ensure they are not dry; replace if necessary.
2. Alcohol Prep: Cleanse the skin to remove oils.
3. Abrasive Tape: Roughen the top layer of the epidermis to ensure electrodes stick well.
4. Trimmers: Trim chest hair to avoid artifacts.

Lead Placement Overview

• Limb Leads: Right Arm (RA), Left Arm (LA), Right Leg (RL), Left Leg (LL)
• Chest Leads (Precordial Leads): V1 through V6

Limb Lead Placement

• Right Arm (RA): Right below the right clavicle
  • Cleanse with alcohol prep, roughen skin, place electrode.
• Left Arm (LA): Right below the left clavicle
  • Follow same prep as RA.
• Right Leg (RL): Right upper quadrant
  • Follow same prep as RA and LA.
• Left Leg (LL): Left upper quadrant
  • Follow same prep as other limb leads.

Chest Lead Placement

• V1: 4th intercostal space, right of the sternum
  • Find sternal notch, move to angle of Louis, count down to the 4th space.
• V2: 4th intercostal space, left of the sternum
  • Mirror placement of V1 on left side.
• V4: 5th intercostal space, midclavicular line
  • Skip V3 initially, find 2nd to 5th intercostal space, place at midclavicular line.
• V3: Between V2 and V4
  • Placed after V4.
• V5: Level with V4, left anterior mid-axillary line
  • Ensure it is inline with V4.
• V6: Level with V5, mid-axillary line
  • Place directly under the armpit, inline with V5.

Summary

• Ensure all lead placements are correct: RA, LA, RL, LL, V1, V2, V3, V4, V5, V6.
• Proper placement reduces artifacts and ensures accurate EKG readings.

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