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Attaching the leads

In the third video of our ECG series, Clinical Simulation Specialist Jasmine Burnett shows how to attach the leads for a standard ECG recording.
Now that the electrodes are correctly placed, this is now the moment in which to apply your leads. So just exposing the electrodes, and then bring over the leads towards your patient. And this is the bit– no matter how prepared you have been, they will consistently tangle. So you just have to do your best to untangle them and get them into the right position. And then you just need to make sure that you’re aware of your left and your right, because that’s going to make a whole difference in terms of the interpretive quality of your ECG. So you just need to make sure.
I’m standing to the patient’s left, so these are going to be my left limb leads, which are the longer ones here. And then I have my right limb leads, which I’m going to feed over onto the right hand side. And these shorter ones here, all the six of them, are the chest leads all known as precordial leads. So generally I’ll just coil them and just tuck them out of the way. So in terms of order, which should have been denoted by the European Guidelines for many years, we literally have the yellow limb lead, which is what normally has got an L on it, and it means left arm.
So you want to rotate your patient’s arm outwards and clip on that electrode. Corresponding to this will be the green electrode, which is for the left leg, and it’s got an F on there for foot. And then as you can see, it holds quite nicely because I’ve inverted it. Then we’re going to move over to the right hand side of the patient, and you’ve got two further electrodes. You have the red, which is for the right arm of the patient. So you just want to clip that on and just get the patient to rest comfortably there. And the last one is your neutral electrode, which actually has no charge whatsoever. And this one will go to the right leg.
Then we’re going to move up to the chest leads. Again, these are colour coded. And on most machines, you will see it’s a standard colour code, again, as denoted by the European Guidelines. And then you have C1. So machines will say V1, but literally it’s your first precordial lead there. Clip that on. And you have your yellow.
But you’ll always know the two different yellows because of the length of the leads. And the precordial leads are always gathered separately from the limb leads, so you won’t have to mix them up. Your V3 is green. Your V4 is brown, or C4. And then your C5 is black electrode. And your C6, final one to complete the precordial leads, is purple. So you don’t actually have to memorise the colour system as long as you read them in the perfect order. And what you want to see when you’ve applied all your electrodes that the contact to the skin remains consistent. There’s no pulling or lifting away from the skin.
At this point, you’ll actually be ready to perform the ECG and make the electrical recording. So you need to make sure you give some instruction to your patient, which is basically if you engaged in conversation prior to this, this is a time where the patient actually needs to be completely silent. They need to breathe nice and gently.
You need to make sure that your body is no longer in contact with the bed. And then you’ll let the patient know once you finish recording. So conversation, coughing, sneezing, or anything else can recommence. If, however, if the patient is not able to remain completely still, you will have to note this on the ECG.
Occasionally if your patient is cold, either in a shocked condition or they had a condition such as Parkinson’s disease where there’s going to be fine tremor– and despite covering your patient, keeping them as warm as you can, their clinical condition, you can’t override that– you would need to note that on the ECG saying, fine tremor from Parkinson’s, fine tremor from shock, to let the person who’s interpreting in the ECG know that when they look at the quality to the ECG and they see that there’s actually additional movement on there, why that was.
But you always do your best to optimise the quality of the placement, optimise your patient position and comfort, and making sure everything’s fully adhered and properly placed before going ahead and recording.

In the third video of our ‘How to record an ECG’ series, Clinical Simulation Specialist Jasmine Burnett shows how to attach the leads for a standard ECG recording.

Embedding your knowledge

You might wish to re-cap on your learning from the previous few steps by downloading our two PDF reference sheets on Limb electrode and lead placement and Chest electrode and lead placement in the downloads section below.

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ECG Assessment: an Introduction for Healthcare Providers

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