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Old 03-30-2016, 07:03 AM
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Default ECG lead placement

Always trying to refine and improve practice.....

So, we do all our ECG's on (research participants) while in a recliner chair without removing clothing or bra's. This can make lead placement a little less precise. Especially in ladies with larger breasts. We work around it for their comfort and get decent ECG's, but I am always looking for better ways to do things if anyone has good ideas that do not require bra removal.
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Old 03-30-2016, 10:06 AM
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Always trying to refine and improve practice.....

So, we do all our ECG's on (research participants) while in a recliner chair without removing clothing or bra's. This can make lead placement a little less precise. Especially in ladies with larger breasts. We work around it for their comfort and get decent ECG's, but I am always looking for better ways to do things if anyone has good ideas that do not require bra removal.
Would you be asking for a work-around for an accurate abdominal assessment that didn't involve taking off the belt and trousers? Nah, didn't think so.

If this is a research project (you didn't say what for) somebody someday may need those EKGs for a reason your principal investigators might not even think about now, or couldn't possibly anticipate. Therefore you owe it to everybody to get proper lead placement to get proper readings.

Take the bras off, push them up over the breasts so they are on the upper chest prn, or have them get unhooked and reach underneath them to palpate the proper intercostals.

And make sure you aren't taking BPs over clothing, either, especially if you're using those already-inaccurate automatic cuffs. And use the larger cuffs for the larger people. They're probably the ones with the big tits.

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Old 03-30-2016, 10:46 AM
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We aren't idiots and no we don't take VS over clothing. The clinicians think the quality of the ECG's are fine. We move the breasts and clothing to get proper placement as needed. The issue is really in getting best quality readings when there is a LOT of breast tissue.

You know what? I have been a nurse for a LONG time and I know and do use best practice for VS etc...... I certainly know how to pick an appropriate cuff.

Your post is condescending and unhelpful and really assumes a lot which reminds me of ivory tower nursing instructors of long ago.
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Old 03-30-2016, 12:58 PM
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We aren't idiots and no we don't take VS over clothing. The clinicians think the quality of the ECG's are fine. We move the breasts and clothing to get proper placement as needed. The issue is really in getting best quality readings when there is a LOT of breast tissue.

You know what? I have been a nurse for a LONG time and I know and do use best practice for VS etc...... I certainly know how to pick an appropriate cuff.

Your post is condescending and unhelpful and really assumes a lot which reminds me of ivory tower nursing instructors of long ago.
Ouch. On the contrary, I have not much to make assumptions with here. The way you described things it wasn't clear that you were removing clothing to get the accurate tracings. I have no idea whether you or anyone else reading my answer might be one who knows about taking BPs over sleeves (because you're not having patients disrobe) is or isn't OK, nor do I have any way to know whether you know that if you put your patient supine and elevate the breast tissue cephalad you'll be able to find the landmarks for accurate V3-5 or 6 lead placement without difficulty. Nor do I have a clue about what your docs are studying or how data collected now could be used in the future. Thus my answer to cover all eventualities, not just for you personally but for anyone else who might read it.

And I am a big-breasted woman who has had a number of lousy-technique EKGs and BPs-over-the-fleece-sleeves in the last six months, ostensibly from experienced clinicians who you'd think would know better. So again, how would I know about your clinic practices?
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Old 03-30-2016, 04:24 PM
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Are the patients in private rooms? ( that might help me think of a better answer )

I'll see what I can find out at work. Our infusion therapy has recliners too and once in a while they do EKGs. I am thinking they do the same thing but not 100% sure.
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Old 04-01-2016, 07:07 AM
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The room is private Meli, but the main issue is that I deal with an elderly vulnerable population that although they understand what we are doing and why the more you undress the more fear based agitation and anxiety it causes so we avoid that as much as possible.
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Old 04-01-2016, 08:06 AM
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The room is private Meli, but the main issue is that I deal with an elderly vulnerable population that although they understand what we are doing and why the more you undress the more fear based agitation and anxiety it causes so we avoid that as much as possible.

Ah, gotcha. I would tend to think if the lady is well-endowed and you need precise readings then bra off ( obviously I would gown or towel cover & I am sure you are already doing that). But I think leaving it on is fine as long as you guys are getting decent readings. I am not sure I am much help though. I think you guys are doing what you can & I think it is great that you care enough to look into better ways just to make sure you have covered every possibility. It is always a good idea to learn or elicit bettering our practices. That is what nursing is all about.
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Old 04-01-2016, 08:12 PM
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I have a male aid who charms all the older ladies with his gentleness and thoughtfulness.

What he does is ask them to hold their breast up, bra on, if they are able, to place the V1-V5 leads. He explains very gently that he has to touch them to place the stickers and to count ribs so he knows where to put them.

He goes very slow and gives the scared LOLs time to react.

I hope that helps.
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