EKG electrode placement in women

[stale]

Is it correct to place the electrodes under the female breasts"

[Tom6459]

There will always be a debate regarding bone vs muscle. Bone does not conduct nearly as well, but muscle contributes to artifact within the tracing  Moving the electrodes from the limbs to the torso helps with this aspect, but it can affect electrical axis (right-ward shift). Axis is determined by the frontal plane leads, not the precordial leads. Limb placement is critical and must be placed consistently within your facility. Again, any electrode placement other than the standard locations (including alternate location due to breast tissue) must be documented.

[kenkeith]

In addition top my previous post, there may be a problem with the accuracy of an EKG as the placement of probes under the breast may effect average direction of electrical activity....amplitude notwithstanding..as I remember there are implications with inner costal space and ribs placed elcectrode properly correlated to the QRS axis.  

[Tom6459]

Placement of electrodes directly on the breast is typically not practiced in the US. Obviously not all breasts are created equal...the standard of care would direct non-stand placement. Any alteration of electrode placement must be documented and serial ECG's should have electrodes placed in the same locations if at all possible. This would make comparison tracings more meaningful clinically.
Bottom line is to check with your facility policy and follow the local standard of care.
v/r,
Tom

[kenkeith]

QUOTE: "Is it correct to place the electrodes under the female breasts?"

It is better to have the electrode conduct from the top of the breast, sometimes it is necessary for placement under the breast.  

>>>>>>For some insight: "Breast tissue appears to have a practically negligible effect on ECG amplitudes (no rise in voltage on verticle axis due to higher resistance...more tissue), and in women, the placement of chest electrodes on the breast rather than under the breast is recommended in order to facilitate the precision of electrode placement at the correct horizontal level and at the correct lateral positions."

Thanks for your question, and if you have a followup you are welcome to respond. Take care.


Rautaharju PM, Park L, Rautaharju FS, Crow R. A standardized procedure for locating and documenting ECG chest electrode positions.

[grendslori]

As a past EKG Supervisor the answer to your question is : yes. When placing the electrodes often times the woman's breast has to be lifted up to place correctly. The tech is feeling for the 'inner costal' spaces which are between the ribs.  

[ireneo]

If I remember correctly on a 12 lead EKG, yes, there are some that go below the breast area as well as above and along the ribs. I'm sure there's a diagram online some place about EKG lead placement.