Electrocardiogram, Right Chest Lead
Unlike a standard 12-lead electrocardiogram (ECG), used primarily to evaluate left ventricular function, a right chest lead ECG reflects right ventricular function and provides clues to damage or dysfunction in this chamber. You might need to perform a right chest lead ECG for a patient with an inferior wall myocardial infarction (MI) and suspected right ventricular involvement. Between 25% and 50% of patients with this type of MI have right ventricular involvement.
Early identification of a right ventricular MI is essential because its treatment differs from treatment for other MIs. For instance, in left ventricular MI, treatment involves administering IV fluids judiciously to prevent heart failure. Conversely, in right ventricular MI, treatment typically requires administration of IV fluids to maintain adequate filling pressures on the right side of the heart. This helps the right ventricle eject an adequate volume of blood at an adequate pressure.
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
Explain the procedure to the patient and answer any questions to decrease anxiety and increase cooperation. Inform him that the doctor has ordered a right chest lead ECG, a procedure that involves placing electrodes on his arms, legs, and chest. Reassure him that the test is painless and takes only a few minutes, during which he’ll need to lie quietly on his back.
Place the patient in the supine position or, if he has difficulty lying flat, in semi-Fowler’s position.
Provide privacy and expose his arms, chest, and legs. (Cover a female patient’s chest with a drape until you apply the chest leads.)
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
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