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Patient positioning when obtaining 12-lead

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This came up at work this week, and much discussion has ensued – I am hoping to get some input from the members here.

The discussion was regarding patient position while obtaining 12 lead. One staff member said that patient must be supine, as having the patient in Fowler’s position may affect axis deviation or other deviations. Another staff member said you can have the patient in Fowlers without having any change in the tracing.

When obtaining a 12-lead ECG, how important is patient positioning? If you do serial 12-leads, if the patient is in a different position during a later reading, will that affect the reading? Does anyone have evidence-based references?

I have looked through several texts I have, and have found the following:

“Although it may not be immediately obvious, the position of the patient can affect the ECG. One reason for differences between tracings obtained in various positions is that although the electrode does not move when the patient changes position, the position of the heart does move relative to the electrode. Strictly speaking, a patient should be supine when the ECG is acquired. This makes comparison of serial ECGs more meaningful. However, this is not always possible or desirable in the chest-pain patient. If the patient is not supine when the tracing is obt5ained, simply note the patient’s position on the 12-lead.”

- Phalen, T., & Aehlert, B. (2006). The 12-Lead ECG in Acute Coronary Syndromes (2nd ed., p. 50). Philadelphia: Elsevier Mosby.

“Ideally, the patient should be lying down (supine). Often, however, this is not possible. A patient with acute onset of chest pain, for example, may not feel comfortable lying down. Therfore, the Fowler’s position (sitting up) is generally used for acute patients.”

- Page, B. (2005). 12-Lead ECG for Acute and Critical Care Providers (p. 6). Upper Saddle River: Pearson Prentice Hall.

The doc and the medic involved in this discussion said that patient positioning does make a difference, but the nurse said not. However, I have spoken with another medic who also said that since the leads are only reading electrical activity, patient positioning isn’t important.

Your input is greatly appreciated.

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Posted · Report post

This came up at work this week, and much discussion has ensued – I am hoping to get some input from the members here.

The discussion was regarding patient position while obtaining 12 lead. One staff member said that patient must be supine, as having the patient in Fowler’s position may affect axis deviation or other deviations. Another staff member said you can have the patient in Fowlers without having any change in the tracing.

When obtaining a 12-lead ECG, how important is patient positioning? If you do serial 12-leads, if the patient is in a different position during a later reading, will that affect the reading? Does anyone have evidence-based references?

I have looked through several texts I have, and have found the following:

“Although it may not be immediately obvious, the position of the patient can affect the ECG. One reason for differences between tracings obtained in various positions is that although the electrode does not move when the patient changes position, the position of the heart does move relative to the electrode. Strictly speaking, a patient should be supine when the ECG is acquired. This makes comparison of serial ECGs more meaningful. However, this is not always possible or desirable in the chest-pain patient. If the patient is not supine when the tracing is obt5ained, simply note the patient’s position on the 12-lead.”

- Phalen, T., & Aehlert, B. (2006). The 12-Lead ECG in Acute Coronary Syndromes (2nd ed., p. 50). Philadelphia: Elsevier Mosby.

“Ideally, the patient should be lying down (supine). Often, however, this is not possible. A patient with acute onset of chest pain, for example, may not feel comfortable lying down. Therfore, the Fowler’s position (sitting up) is generally used for acute patients.”

- Page, B. (2005). 12-Lead ECG for Acute and Critical Care Providers (p. 6). Upper Saddle River: Pearson Prentice Hall.

The doc and the medic involved in this discussion said that patient positioning does make a difference, but the nurse said not. However, I have spoken with another medic who also said that since the leads are only reading electrical activity, patient positioning isn’t important.

Your input is greatly appreciated.

Well the medic was right in the sense, that if you are looking to determine STEMI or not, position will have very little effect. However, it could shift the axis, only slightly. In the prehospital world, I would venture to state that Fowler's or supine are both appropriate for obtaining a 12-lead ECG. There are many other factors, that skew 12-leads, that should be of more concern.

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For me, I have found that having a patient supine, if possible, works the best.

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