Accuracy in precordial ECG lead placement: Improving performance through a peer-led educational intervention

Medani, Samar; Hensey, Mark; Caples, N; Owens, Patrick

doi:10.1016/j.jelectrocard.2017.04.018

Cited by 23 publications

(16 citation statements)

References 7 publications

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“…Our sample size was relatively small and self-selecting, which will impact the generalisability of the results; however, our findings are similar to those from previous studies involving other health professionals [McCann et al, 2007;Rajaganeshan et al, 2008;Medani et al, 2018) and it does suggest a pattern of inaccuracy that causes concern. It could be argued that participants who attend a professional exhibition and conference may be more motivated than the wider paramedic population and if this hypothesis is accepted, it is likely that the accuracy of electrode placement in the wider paramedic profession will be less accurate than in our study population.…”

Section: Resultssupporting

confidence: 84%

“…This study also saw a frequent malposition of V5 and V6. Medani et al(2018) found that only 10% of participants (doctors, nurses and cardiac technicians) correctly applied all of the leads with the most common errors being the placement of the V1 and V2 leads too superiorly, and the V5 and V6 leads too medially. McCann et al (2007) found clinically significant variability in the identification of standardized precordial electrode positions among senior emergency clinicians.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of ECG chest electrode placements by paramedics: an observational study

Gregory

Lodge

Kilner

et al. 2019

British Paramedic Journal

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Introduction: The main aim of this study was to ascertain the accuracy of the chest lead placements by registered paramedics.Methods: Registered paramedics who attended the Emergency Services Show in Birmingham in September 2018 were invited to participate in this observational study. Participants were asked to place the chest electrodes on a human male model in accordance with their current practice. Correct positioning was determined against the Society for Cardiological Science and Technology’s 2017 clinical guidelines for recording a standard 12-lead electrocardiogram, with a tolerance of 19 mm being deemed acceptable based upon previous studies. Participants were also asked to indicate what they believed to be the correct positions on an anatomical diagram, and to describe the landmarks and positions in writing.Results: A total of 52 eligible participants completed the study. Measurement of electrode placement in the craniocaudal and mediolateral planes showed a high level of inaccuracy, with 3/52 (5.8%) participants able to accurately place all chest leads. In leads V1‐V3, the majority of incorrect placements were related to vertical displacement, with most participants able to identify the correct horizontal position. In V4, the tendency was to place the lead too low and to the left of the pre-determined position, while V5 tended to be below the expected positioning but in the correct horizontal alignment. There was a less defined pattern of error in V6, although vertical displacement was more likely than horizontal displacement. Only 1.9% of participants were able to correctly label the diagram and 1.9% were correctly able to write down the landmarks and correct positions.Conclusion: Our study identified a high level of variation in the placement of chest ECG electrodes, which could alter the morphology of the ECG. There was also a high degree of inaccuracy in the written components of the study, which suggests that underpinning knowledge is likely to be a major factor behind this variation. From a patient safety perspective, we would advocate that paramedics leave the chest electrodes in situ to allow hospital staff to assess the accuracy of the placements. Further consideration needs to be given to initial and ongoing training of ECG electrode placement to improve performance.

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Section: Resultssupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Accuracy of ECG chest electrode placements by paramedics: an observational study

Gregory

Lodge

Kilner

et al. 2019

British Paramedic Journal

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show abstract

“…A report by Grossi and Lynch [19] recommended education and training of ECG lead placement for both medical and nursing staff, irrespective of grades in anticipation that this will diminish the figures of lead misplacements and inaccurate recording which can represents a risk to patient management. Medani et al [20] recommended regular refreshers training, supported by peers, to ensure practitioners maintain their competency at correct ECG lead placement.…”

Section: Discussionmentioning

confidence: 99%

An evaluation of Electrocardiogram (ECG) lead placement training in an Integrated Care Organisation

Purran

Evans

Ramjan

2019

JNEP

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For several years, in-house clinical skills training has been used in hospitals and clinical settings. There has been a dramatic increase in recent years in the usage of clinical skills training to underpin role development and improve practice standards among healthcare professionals. This article describes the evaluation of an evidence-based electrocardiogram (ECG) lead placement training that was devised and implemented by the Whittington Health National Health Service (NHS) Trust Clinical Education Department to meet the gap in training needs. The findings will provide the department with facts if the trust is on the right path of accomplishing its planned goals to support role expansion, expert improvement and alteration in practice to improve patient care.

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“…This study also saw a frequent malposition of V 5 and V 6 . Medani et al [14] found that only 10% of participants (doctors, nurses and cardiac technicians) correctly applied all of the leads with the most common errors being the placement of the V 1 and V 2 leads too superiorly, and the V 5 and V 6 leads too medially. McCann et al [15] found clinically significant variability in the identification of standardized precordial electrode positions among senior emergency clinicians.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of ECG Chest Electrode Placements by Paramedics; an observational study

Gregory

Lodge

Kilner

et al. 2019

Preprint

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Background: The use of the 12-lead ECG is common in UK paramedic practice but its value depends upon accurate placement of the ECG-electrodes. Several studies have shown widespread variation in the placement of chest electrodes by other health professionals but no studies have addressed the accuracy of paramedics. The main objective of this study was to ascertain the accuracy of the chest lead placements by registered paramedics. Methods: Registered paramedics who attended the Emergency Services Show in Birmingham in September 2018 were invited to participate in this observational study. Participants were asked to place the chest electrodes on a male model in accordance with their current practice. Correct positioning was determined against the Society for Cardiological Science & Technology's Clinical Guidelines for recording a standard 12-lead electrocardiogram (2017) with a tolerance of 19mm being deemed acceptable based upon previous studies. Results: 52 eligible participants completed the study. Measurement of electrode placement in the craniocaudal and mediolateral planes showed a high level of inaccuracy with 3/52 (5.8%) participants able to accurately place all chest leads. In leads V1 - V3, the majority of incorrect placements were related to vertical displacement with most participants able to identify the correct horizontal position. In V4, the tendency was to place the lead too low and to the left of the pre-determined position whilst V5 tended to be below the expected positioning but in the correct horizontal alignment. There was a less defined pattern of error in V6 although vertical displacement was more likely than horizontal displacement. Conclusion: Our study identified a high level of variation in the placement of chest ECG electrodes which could alter the morphology of the ECG. From a patient safety perspective, we would advocate that paramedics leave the chest electrodes in situ to allow hospital staff to assess the accuracy of the placements.

show abstract

Accuracy in precordial ECG lead placement: Improving performance through a peer-led educational intervention

Cited by 23 publications

References 7 publications

Accuracy of ECG chest electrode placements by paramedics: an observational study

Accuracy of ECG chest electrode placements by paramedics: an observational study

An evaluation of Electrocardiogram (ECG) lead placement training in an Integrated Care Organisation

Accuracy of ECG Chest Electrode Placements by Paramedics; an observational study

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