How to Place a 12-Lead ECG: Electrode Location & Chart
12 Lead ECG Placement: This video explains how to place a 12 lead ECG step-by-step! Diagrams, mnemonics, charts, electrode locations, and more included!
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What is a 12 Lead ECG?
A 12 lead ECG is a simple test that records and measures the electrical activity of the heart.
An ECG (also called EKG) stands for electrocardiogram, and it is often used when a patient is experiencing chest pain, shortness of breath, palpitations, etc.
A 12 lead ECG evaluates the heart rate, heart rhythm, and other features of the heart.
A 12 lead ECG can help diagnose various cardiac conditions, including heart attacks, heart blocks, arrhythmias (irregular heart rate or rhythm), etc.
Parts of a 12 Lead ECG
A 12 lead ECG uses 10 electrodes and 10 lead wires.
Electrodes are sticky conductive pads placed on the body in certain positions, and they allow the electrical activity of the heart to be recorded.
The lead wires are color-coded cables that connect to the electrodes, and they transmit the electrical activity of the heart to the ECG machine.
The lead wires must go in the correct position, and they are marked with a location and color.
Let’s review where the electrodes and different colored lead wires are placed….and a mnemonic to remember it all!
Important: Don’t miss the summary tables at the end, and leave a comment down below if this lecture helps you!
12 Lead ECG Placement: Definition of electrodes vs lead wires. Electrodes are the adhesive conductive pads. Lead wires are the color-coded cables.
12 Lead ECG Placement
A 12 lead ECG uses 10 electrodes and lead wires listed below:
RA (right arm) = White
RL (right leg) = Green
LA (left arm) = Black
LL (left leg) = Red
V1 (chest) = Red
V2 (chest) = Yellow
V3 (chest) = Green
V4 (chest) = Blue
V5 (chest) = Orange
V6 (chest) = Purple
The 10 electrodes and lead wires can be divided into 2 types:
4 limb electrodes and lead wires
Placed on the extremities
6 precordial electrodes and lead wires
Placed on the chest
How do you remember where to place all the different electrodes and lead wires??
Let’s look at some mnemonic memory tricks to help!
BONUS: Why does a 12 lead ECG only use 10 electrodes….keep reading to find out!
Note: The AHA color system is being used.
12 Lead ECG Placement: Diagram showing limb and precordial electrode and lead wire locations. Circles = Electrodes; Colors = Lead Wires
12 Lead ECG Mnemonic
Use the following 12 lead ECG mnemonics to remember where to place the lead wires:
“White on the Right”
White lead wire (RA) goes on the right arm
“Clouds over Grass”
White lead wire (RA) over green lead wire (RL)
“Smoke over Fire”
Black lead wire (LA) over red lead wire (LL)
“Ride Your Green Bike On Pavement”
Red (V1), yellow (V2), green (V3), blue (V4), orange (V5), purple (V6)
Let’s walk through each mnemonic, and where to place the electrodes and lead wires below!
12 Lead ECG: Limb Placement
Let’s start with where to place the limb electrodes and lead wires.
Remember, the limb electrodes and lead wires go on the extremities and there are 4 of them.
The mnemonic memory tricks to remember the limb electrodes and lead wires include:
“White on Right”
“Clouds over Grass”
“Smoke over Fire”
“White on Right”
Use “white on right” to remember the white lead wire goes on the right arm.
Place the electrode on the right arm, typically above the right wrist.
Then connect the white lead wire labeled “RA” (right arm) to the electrode.
12 Lead ECG Placement: Use the mnemonic “white on right” to remember the limb electrode and lead wire locations. Diagram: RA = Right Arm
“Clouds over Grass”
Use “clouds over grass” to remember the white lead wire (clouds) goes over the green lead wire (grass).
We already know the white lead wire is the right arm, so the green lead wire labeled “RL” is the right leg.
Place the electrode on the right leg, typically above the right ankle.
Then connect the green lead wire labeled “RL” (right leg) to the electrode.
12 Lead ECG Placement: Use the mnemonic “clouds over grass” to remember the limb electrode and lead wire positions. Diagram: RA = Right Arm; RL = Right Leg
“Smoke over Fire”
Use “smoke over fire” to remember the black lead wire (smoke) goes over the red lead wire (fire).
The black lead wire is the left arm, and the red lead wire labeled “LL” is the left leg.
Place the left arm electrode on the left arm, typically above the left wrist.
Then connect the black lead wire labeled “LA” (left arm) to the electrode.
Place the left leg electrode on the left leg, typically above the left ankle.
Then connect the red lead wire labeled “LL” (left leg) to the electrode.
12 Lead ECG Placement: Use the mnemonic “smoke over fire” to remember the limb electrode and lead wire locations. Diagram: RA = Right Arm; RL = Right Leg; LA = Left Arm; LL = Left Leg
Note: You may see some literature suggesting the limb electrodes can be placed anywhere on the limbs, as long as both sides are symmetrical.
However, studies have suggested changes to the ECG morphology the more proximal the electrodes are placed on the limbs.
As a result, make sure to follow your ECG and institutional placement protocols.
12 Lead ECG Placement: Diagram showing the location and position of limb electrodes and lead wires
12 Lead ECG: Precordial Placement
Now that we know where to place the limb electrodes and lead wires, let’s walk through where to place the precordial electrodes and lead wires.
Remember, the precordial electrodes and lead wires go on the chest and there are 6 of them.
The precordial lead wires are labeled V1-V6.
The mnemonic to remember the order of the precordial lead wire colors is:
“Ride Your Green Bike On Pavement”
Ride = Red = V1
Your = Yellow = V2
Green = Green = V3
Bike = Blue = V4
On = Orange = V5
Pavement = Purple = V6
12 lead ECG Placement: Mnemonic for nursing, EMTs, EMS, etc. on precordial electrode and lead wire colors and location
“Ride” = Red = V1
Place the electrode in the 4th intercostal space, right of the sternum.
Then connect the red lead wire labeled “V1” to the electrode.
Reminder: The left leg lead wire was also red, so make sure to always check the lead wire labels before placing them for accuracy.
12 lead ECG Placement: Mnemonic for precordial electrode and lead wire colors and locations. Diagram: V1 position
“Your” = Yellow = V2
Place the electrode in the 4th intercostal space, left of the sternum.
Then connect the yellow lead wire labeled “V2” to the electrode.
12 lead ECG Placement: Mnemonic for precordial electrode and lead wire colors and locations. Diagram: V2 position
“Green” = Green = V3
Place the electrode midway between V2 and V4.
Then connect the green lead wire labeled “V3” to the electrode.
Tip: It’s easier to place V4 first, then go back to V3 and place it between V2 and V4 (as shown in the diagram below).
Reminder: The right leg lead wire was also green, so make sure to always check the lead wire labels before placing them for accuracy.
12 lead ECG Placement: Mnemonic for precordial electrode and lead wire colors and locations. Diagram: V3 position (V4 included to show position of V3)
“Bike” = Blue = V4
Place the electrode in the 5th intercostal space, midclavicular line.
Then connect the blue lead wire labeled “V4” to the electrode.
Tip: It’s easier to place V4 first, then go back to place V3 (V3 omitted below to better visualize placement order)
12 lead ECG Placement: Mnemonic for precordial electrode and lead wire colors and locations. Diagram: V4 position (V3 omitted to better visualize placement order)
“On” = Orange = V5
Place the electrode in the 5th intercostal space, anterior axillary line.
Then connect the orange lead wire labeled “V5” to the electrode.
12 lead ECG Placement: Mnemonic for precordial electrode and lead wire colors and locations. Diagram: V5 position
“Pavement” = Purple = V6
Place the electrode in the 5th intercostal space, mid-axillary line.
Then connect the purple lead wire labeled “V6” to the electrode.
12 lead ECG Placement: Mnemonic for precordial electrode and lead wire colors and locations. Diagram: V6 position
Bonus Memory Trick!
Here is another memory trick to remember the precordial lead wires!
Use the colors of a traffic light to remember V1-V3.
V1 is red, V2 is yellow, and V3 is green.
Then use the mnemonic “BOP” to remember V4 is blue (B), V5 is orange (O), and V6 is purple (P).
12 lead ECG Placement: Mnemonic for precordial electrode and lead wire locations and positions. Diagram: V1-V6 colors
12 Lead ECG Placement: Modified
You may see some literature placing the limb electrodes and lead wires on the torso instead of the extremities, as shown in the image below.
Placing limb electrodes on the torso may be necessary for:
An amputated extremity
Infants (to reduce motion artifact)
Excessive limb movement
It is important to note, studies have suggested potentially significant changes to the ECG morphology when the limb electrodes are placed on the torso.
As a result, if the limb electrodes are placed on the torso, then it is good practice to notify the provider and write “torso-positioned limbs” on the ECG.
Reminder: Follow ECG and institutional placement protocols.
12 Lead ECG Placement: Diagram showing modified placement of limb electrodes and lead wires (torso location and position).
Why is it called a 12 Lead ECG when there are only 10 electrodes?
Now for the important question!
Why is it called a 12 lead ECG if there are only 10 electrodes??
The short answer….electrodes and lead wires are NOT the same as leads!
Many people incorrectly call the lead wires leads when placing them.
The leads are what you see on the ECG and are labeled different than the lead wires (i.e. lead I, II, III, aVR, aVL, aVF).
The lead wires label where to place the wires on the body, and the ECG leads label the “view” of the electrical activity recorded.
So what do we mean by that?
A lead is a recording of the electrical activity of the heart from a particular angle or perspective.
The 10 electrodes create 12 different views of the heart, and the electrical activity of the heart is recorded from those 12 angles or perspectives.
These 12 views make up the 12 leads seen on a 12 lead ECG.
Important: Some electrodes are involved in creating more than one lead, and this is why a 12 lead ECG uses only 10 electrodes!
Why does a 12 lead ECG only have 10 electrodes? The 10 electrodes create 12 different “electrical views” of the heart. These views are called leads.
What is a Lead? A lead is a recording of the electrical activity of the heart from a particular angle, created by the electrodes.
12 Lead ECG Chart
Here is a summary table reviewing 12 lead ECG placement, including the location and position of the electrodes and lead wires!
Remember to leave a comment down below if you enjoyed this lecture!
12 Lead ECG Placement Chart: Limb and precordial electrode and lead wire locations, colors, and positions. Mnemonic for nursing, EMTs, EMS, etc.
ReferencesCadogan M.; ECG Lead Positioning; Life in the Fast Lane; January 2022; Accessed August 2023; https://litfl.com/ecg-lead-positioning/Tung R.; Electrocardiographic Limb Leads Placement and Its Clinical Implication: Two Cases of Electrocardiographic Illustrations; National Library of Medicine; 2021; 14: 229-230; Accessed August 2023; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415387/Jowett N., Turner A., Cole A., Jones P.; Modified electrode placement must be recorded when performing 12-lead electrocardiograms; National Library of Medicine; 2005 Feb; 81(952): 122-125; Accessed August 2023; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743200/My EKG; EKG Electrode Color Coding; Last updated May 2023; Accessed August 2023; https://en.my-ekg.com/tips-ekg/ekg-electrode-color-coding.htmlKumar A.; ECG Color Codes Explained; Biometric Cables; February 2020; Accessed August 2023; https://www.biometriccables.in/blogs/blog/ecg-colour-codes-explainedVitali; 12-Lead ECG Placement Guide; January 2023; Accessed August 2023; https://www.vitalipartners.com/blog/2023/01/12-lead-ecg-placement/3D ECG Leads; 12 Lead ECG - Correct ECG Lead Placement; Accessed August 2023; https://www.3decgleads.com/ecg-leads