Electrocardiogram, Posterior Chest Lead
Because of the location of the heart’s posterior surface, changes associated with myocardial damage may not be apparent on a standard 12-lead electrocardiogram (ECG). To help identify posterior involvement, some practitioners recommend using posterior chest leads in addition to the limb leads of the 12-lead ECG. Despite lung and muscle barriers, posterior leads may provide clues to posterior wall infarction so that appropriate treatment can begin.
Multichannel ECG machine with recording paper ▪ disposable pregelled electrodes ▪ dry washcloth or 4″ × 4″ gauze pads ▪ Optional: clippers, moist cloth, soap, alcohol pad, marking pen.
Preparation of Equipment
Place the ECG machine close to the patient’s bed. Plug the cord into the wall outlet or, if the machine is battery operated, ensure functioning. Turn on the machine, and input the required patient information. Keep the patient away from electrical fixtures and power cords.
Verify the doctor’s order.
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.4
Provide privacy and explain the procedure to the patient. Answer all questions to decrease anxiety and increase cooperation. Tell him that the test records the heart’s electrical activity and that it may be repeated at certain intervals. Emphasize that no electrical current will enter his body. Also, tell him that the test typically takes about 5 minutes.
Position the patient supine in the center of the bed with his arms at his sides. You may raise the head of the bed to promote comfort. Expose the patient’s arms and legs, and cover him appropriately. His arms and legs should be relaxed to minimize muscle trembling, which can cause electrical interference.
Place the limb lead electrodes on flat, fleshy areas. Avoid muscular and bony areas. If the patient has an amputated limb, choose a site on the stump.
Prepare the application sites by washing them with soap and water and drying them thoroughly to enhance limb lead electrode contact. If the patient is diaphoretic or if the skin is oily or has lotion on it, you may use an alcohol pad. Clip excessive hair.5
Rub the electrode sites briskly with a dry washcloth or gauze pad.5
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