Lead placement

The Resuscitation Council UK (2000) recommends that for the purposes of monitoring, lead II should be selected as it provides the clearest view of the P wave and the QRS complex. A lead II trace is obtained by placing the red (positive) electrode on the right shoulder, the yellow (negative) electrode on the left shoulder and the black or green (neutral) electrode below the left border of the ribcage.

To ensure a high-quality ECG trace, consider the following principles.

• Maintain good skin contact (remove chest hair as it may interfere with adhesion of electrodes to skin).

• Keep skin surface dry (rub the sites selected for placement of electrodes with dry gauze).

• Apply even pressure only on adhesive area to ensure a good seal.

• Avoid placing electrodes where defibrillation gel pads might be positioned in the event of a cardiac arrest.

• Avoid interference from patient movement, electrical equipment and during CPR by attaching the ECG electrodes over bone rather than muscle.

• Apply large adhesive multipurpose electrodes as recommended.

• Check ECG or replace electrodes if trace is poor or interrupted.

• Set alarms for upper and lower limits of heart rate in line with local practice.

• Record the patient's details, symptoms, date and time alongside the trace or ECG recording.

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