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Fig. 5.3 ECG lead placement. Left image: three lead ECG configuration with white (right arm), black (left arm) and red (left leg) lead placement. Right image: five lead ECG configuration adds a green (right leg), and a brown lead in the V5 position.

ECG Monitoring:

A three-lead system that includes electrodes for the right arm (RA), left arm (LA), and left leg (LL) is commonly used for healthy patients undergoing minor or moderate-risk surgical procedures. A five-lead system is commonly used for patients who have risk factors for cardiac disease, advanced age, and / or significant comorbid conditions and are undergoing moderate to high-risk surgical procedures. The pulse oximeter probe is typically placed on a digit of the patient’s hand on the same side as the intravenous access. See Chapter 10 for a discussion on intraoperative monitors.

The saying “white is right and smoke over fire” is a simple saying to recall the positioning of the while, black and red electrodes in a simple three-lead system.