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Best placement for the limb leads during and ECG... November 15 2014

A question was recently asked of Darlene at QRS Educational Services regarding the best placement for the limb leads when doing an ECG. Please read the proposed question and Darlene's response below for details as well as links to research and recommendations on this topic.

Question: "I wonder if you can help me answer a question that I can't seem to find a consistent answer to. What is the current recommendation for the limb lead placement when doing a 12 lead ECG? We have a varied practice and would like to be consistent. Is there a reference you can recommend?

FROM NELSON BC

Darlene's Response: Thank you for your email and request. I had to do some research before responding to you. There is a lot of practice variability in placing the limb leads and I have attached 2 articles on the topic that will help address your question.

Alternative Lead Apllications and Modified electrode placement must be recorded when performing 12-lead electrocardiograms

The recommendations are: arm leads are placed distal to the shoulder and legs leads distal to the hips. According to the recommendations, that means the arm leads can be placed anywhere as long as they are distal to the shoulders.

The second article is very interesting as it studied the application of the limb leads on the torso, which we do in our standard stress testing. However, their findings were that this is not a recommended placement for a standard 12 lead ECG. If the limb leads are placed on the torso (let's say it was done that way because the patient was very unstable, heavily clothed on the legs and the ECG needed to be as quickly as possible), there needs to be a notation on the ECG that this was done.

I hope this helps.

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Best placement for the limb leads during and ECG... November 15 2014

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