How to Place a 12-Lead ECG

Overview

• A 12-lead ECG uses 10 electrodes, not to be confused with lead wires or leads.
• 10 electrodes provide 12 different views or leads of the heart.
• Key Definitions:
  • Electrodes: Sticky pads on the body that record heart's electrical activity.
  • Lead Wires: Color-coded wires that connect electrodes to the ECG machine.
  • Leads: Views of heart's electrical activity from specific angles.

Types of Electrodes

1. Limb Electrodes:
   • Placed on extremities.
   • Total: 4 electrodes.
2. Precordial Electrodes:
   • Placed on the chest.
   • Total: 6 electrodes.

Mnemonics for Limb Electrodes Placement

• "White on the Right":
  • White lead wire on right arm.
  • Electrode placed above right wrist.
  • Connect to RA (Right Arm).
• "Clouds over Grass":
  • White (clouds) over Green (grass).
  • Green lead wire on right leg.
  • Electrode placed above right ankle.
  • Connect to RL (Right Leg).
• "Smoke over Fire":
  • Black (smoke) over Red (fire).
  • Black lead wire on left arm.
  • Electrode placed above left wrist.
  • Connect to LA (Left Arm).
  • Red lead wire on left leg.
  • Electrode placed above left ankle.
  • Connect to LL (Left Leg).

Mnemonics for Precordial Electrodes Placement

• "Ride Your Green Bike on Pavement":
  • V1: Red, 4th intercostal space, right of sternum.
  • V2: Yellow, 4th intercostal space, left of sternum.
  • V3: Green, midway between V2 and V4.
  • V4: Blue, 5th intercostal space, midclavicular line.
  • V5: Orange, 5th intercostal space, anterior axillary line.
  • V6: Purple, 5th intercostal space, mid-axillary line.

Additional Memory Tricks

• Traffic Light Colors for V1-V3:
  • V1: Red
  • V2: Yellow
  • V3: Green
• "BOP" Mnemonic:
  • B: Blue (V4)
  • O: Orange (V5)
  • P: Purple (V6)

Alternative Electrode Placement

• Torso Placement:
  • Used for amputated extremities or to reduce motion artifact.
  • Significant ECG morphology changes possible if electrodes on torso.
  • Notify provider by noting "torso position limbs" on ECG.

Summary

• 12-lead ECG: 10 electrodes, 10 lead wires.
• Limb electrodes: Remember mnemonics for wire color (white, green, black, red).
• Precordial electrodes: Use "Ride Your Green Bike on Pavement" mnemonic.

Reminder

• Follow ECG and institutional placement protocols.