Electrode Placement

Electrode Placement and Lead Selection

Proper electrode placement is essential in order to acquire accurate EKG strips. Most EKG monitor manufacturers have a set of placement guidelines specific to their products. Always adhere to your facility policy and procedure when administering any patient care.

The following are some general guidelines.

Skin preparation:
- Remove hair from electrode placement site (electric clippers are preferred over shaving due to abrasion injury associated razor use).
- Rub site briskly with alcohol pad.
- Rub site with 2x2 gauze.
- Place electrode. Be sure that the electrode has adequate gel and is not dry.

3 lead placement:

Depolarization wave moving toward a positive lead will be upright.

Depolarization wave moving toward a negative lead will inverted.

Depolarization wave moving between negative and positive leads will have both upright and inverted components.

Five lead placement allows viewing of all leads within the limits of the monitor.

Lead selection

Lead II is the same as standard lead two as seen in a 12 lead EKG.
- It is the most common monitoring lead.
- It is not the optimal monitoring lead.
V1 lead is the best lead to view ventricular activity and differentiate between right and left bundle branch blocks.
- V1 is viewed with a five lead system.
- Therefore, MCL1 was designed to overcome the inconvenience of a five lead system and provide all the advantages of V1 viewing.

Trouble shooting and tips

Change the electrodes everyday.
Make sure all electrical patient care equipment is grounded.
Be sure all the lead cables are intact. Some manufacturers require changing the cables periodically.
Be sure the patient's skin is clean and dry.
Make sure the leads are connected tightly to the electrodes.
Patient movement frequently causes interference. For example, the action of brushing teeth may cause interference that mimics V-tach.