The electrocardiogram (ECG) is arguably one of the greatest advancements in 20th-century medicine. With the ability to see how a heart beats in an instant, the ECG has saved countless lives in doctor’s offices, emergency rooms and hospitals around the world. What we don’t often consider is the skill it takes to use a modern marvel like the ECG, especially on the smallest patient.
ECG Placement in an Adult
Since there are only 10 electrodes to capture 12 pictures of the heart’s function, it is important that each is placed in the correct position. In an adult, V1 is placed on the fourth intercostal space to the right of the sternum while V2 is placed in the corresponding intercostal space to the left. V3 is placed midway between V2 and V4 which is placed in the 5th intercostal space at the midclavicular line. V5 is placed at the same level as V4, along with the anterior axillary line. V6 is placed at the midaxillary line at the same level as V4 and V5. Finally, RL and LL are placed anywhere above the ankle and below the torso on the right and left sides, respectively. RA and LA are placed anywhere between the shoulder and elbow on the right and left sides, respectively. Failure to place any of the ten electrodes in their proper place will result in inaccurate readings that often look like serious heart problems.
How Neonatal ECG Placement is Different
In most cases, a 12 lead ECG is not used on a neonatal patient because of the limited size of their body. The intercostal spaces are not wide enough for accurate electrode placement, and the space between the electrodes does not allow for 12 accurate leads. Instead, a three-wire lead set is necessary for proper measurement. In this case, the ECG is also used to detect the best possible respiratory data through the ECG thoracic impedance technique. Patches are placed on the chest directly across from each other to measure the neonate’s chest movement. RA (white) is placed under the left clavicle, along the mid-clavicular line in the rib cage. LA (black) is placed along the right sternal border, inside the fourth intercostal space. LL (red) is placed on the lower left side of the abdomen.
Differences in Data
The data from a neonate’s ECG will read a lot like an adult who has right ventricular hypertrophy. The axis is rightward, there is a dominant R wave, their heart rate is between 90 and 190 beats per minute, their cardiac output has a faster rate with shorter intervals. There may also be a T wave inversion and sinus arrhythmia that changes with the patient’s breathing.
Measuring a neonatal patient’s heart rate with an ECG is a skill acquired through years of experience and a steady hand. Having the right equipment to measure that heart rate only requires a relationship with a medical equipment provider that understands you. Contact the customer service experts at Foremost Medical Equipment for all of your neonatal ECG needs.