Tips for Placing the Electrocardiogram Electrodes

With this article we are trying to give you some tricks for placing electrocardiogram electrodes. Tricks and recommendations that we have collected from our experience, as well as those of several colleagues from the My EKG team.

We hope that these tips, which are so simple that they are sometimes overlooked, are useful in your daily work.

Tips for Correctly Performing an EKG

Related article: How to perform an electrocardiogram.

First Trick: Uncover chest, ankles and hands.

Image courtesy of imagerymajestic / FreeDigitalPhotos.net

It is important to remove all garments that cover the chest, wrists or ankles, as well as other objects present in the areas where the electrodes are placed, because they make it more difficult to obtain the EKG correctly.

Women will always be instructed to remove their bra, otherwise, it is necessary to place the precordial electrodes below the 5th intercostal space. If that occurs, the EKG would be poorly performed.

Other objects on the ankles and wrists, such as chains or watches, must also be removed and cell phones or electronic devices must be set aside. All of this improves the quality of the electrocardiogram, decreasing the appearance of artifacts.

Second Trick: Assure the patient's dignity.

This is the main complaint of patients in social networks, especially by women.

While we have recommended to completely undress the chest as the first advice, this should be done while assuring the dignity of the patient.

It is advisable to deliver a hospital gown or at least cover the chest with a sheet while the electrocardiogram is performed, provided it is not in contact with the electrodes.

Third Trick: If there is hair, shave it.

Image courtesy of Keerati / FreeDigitalPhotos.net

This is another point that is often forgotten, because in patients with a lot of hair on their chest it is clear that you must shave it, but we also recommend shaving even if the patient has little hair.

Why? For two reasons:

It guarantees a better contact of the electrode with the skin and above all (very important) you save the patient from a painful hair removal when removing the electrode.

Fourth Trick: Clean the electrode placement zones.

Fully recommended for all patients. Not because they come dirty (some do, we aren’t going to lie), but because sweat, perfumes, or creams, decrease the adhesion of the electrodes, worsening the quality of the EKG, and therefore its correct interpretation.

You can clean the skin with gauze soaked in alcohol solution or simply with a towel.

More information: How to perform an electrocardiogram.

Tricks for correctly placing the electrodes

Related article: Electrocardiogram electrodes.

There are two color codes for the electrodes, the International Electrotechnical Commission (IEC) and the American Heart Association (AHA).

Limb Electrodes:

Currently we don’t have a trick for the color code of the AHA, but we do have one for the IEC.

The colors of the peripheral electrodes of the IEC are reminiscent of the traffic light: red, yellow and green, since they are placed in that order in the clockwise direction.

Starting with the right arm (red), left arm (yellow), left leg (green), right leg (Black). It’s that easy.

Precordial Electrodes:

In the precordial electrodes the location is more important than the colors.

The most frequent question is: how do I locate the fourth intercostal space? Our advice is to count the spaces between the ribs along the edge of the sternum until you reach the fourth.

Once you have followed our trick, place V1 and V2 on the right and left edges of the sternum in the fourth intercostal space.

Next trick: place V4 before V3.

Where? In an intercostal space lower than V2, on the imaginary line that descends from the center of the clavicle. Now place V3, right at the midpoint of the line going from V2 to V4.

And finally, V5 and V6 go in line with V4 on the anterior axillary line and on the midaxillary line respectively (read location of the EKG electrodes).

More information: Electrocardiogram electrodes.

Tricks with different types of electrodes

Suction cup type: try to make a suitable suction to set the electrode, but avoid excessive suction, because it can leave redness or even bruises.

Clothespin type: over time, the quality of contact with the skin may decrease, we recommend moistening the electrode with an alcohol solution to increase the conduction, improving the EKG result.

Clip type: always shave when necessary (don’t forget it). Connect the cable and the electrode before placing the electrode on the patient, doing so after results in putting pressure against the patient's skin (and sometimes against the ribs) which can be painful.

Seal type: shave the patient. Ensure a correct "bite" of the clamps on the electrode's ear, as they usually deteriorate with use.