Intraoperative ECG Lead Placement. Brian Matthews SRNA Nicholas Stoddard SRNA David Perkins SRNA. Monitoring Basics. Impulse toward positive is an up swing; away from positive is down. J point, or “junction point”, is located at junction of S wave and start of ST segment.
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Brian Matthews SRNA
Nicholas Stoddard SRNA
David Perkins SRNA
the J point.
V2: left sternal border 4th intercostal space
V3: halfway between V2 and V4
V4: left 5th intercostal space, mid-clavicular line
V5: horizontal to V4, anterior axillary line
V6: horizontal to V5, mid-axillary line
episode of ECG evidence suggestive of prolonged
“First and foremost, if a preoperative 12-lead ECG has been done, “fingerprinting” of the tracing should serve as the primary guide for lead selection during the perioperaive period. If the baseline 12-lead shows significant primary ST-segment changes in leads V3,V4 and V5, then this lead set should be prioritized for continuous display in the operating room.” (Nagelhout, & Plaus, 2010)
“A preoperative resting 12-lead ECG is recommended for patients with at least one clinical risk factor who are undergoing vascular surgical procedures and for patients with known CAD, peripheral arterial disease, or cerebrovascular disease who are undergoing intermediate-risk surgical procedures. A perioperative ECG is reasonable in persons with no clinical risk factors who are about to undergo vascular surgical procedures and may be reasonable in patients with at least one clinical risk factor who are undergoing intermediate-risk operative procedures” (Barash, et al. 2009)