A 12-Lead EKG is an essential part of a stress test. A stress test, maximal exercise test, is performed in a research area on a treadmill. The EKG is connected to a computer, and 10 electrodes are placed in specific areas on the contestant. The steps that follow, will aid you in placing the electrodes on the subject in the specified areas. Please note that the names of each of the leads are standard.


Steps

1. You need to remove any hair from the subjects mid chest line (approximately 1 inch on either side of the nipple line).
2. Stand, facing your subject and him facing you, have the subject raise their left arm, and place it on your right shoulder. There should be a small indention in the skin, right next to the shoulder joint and under the collarbone. Using a dry erase marker, place a dot in this indention. This will be the location of the Left Arm Lead.
3. Complete Step 2, with the subject’s right arm.
4. Locate the subject’s two hip bones. Using the marker, place a dot just above the top of the hip bone, at the same level as the navel. Complete this on both sides of the navel. These two dots will be the Leg Leads.
5. Locate the clavicle on the subject’s right side. Place two fingers, just below the clavicle, and just above the top rib in the first intercostal space.
6. Make your way down the subject’s chest counting intercostal spaces. When you get to the fourth space, STOP. (you should be about to the bottom of the sternum)
7. Using your marker, place a dot in the fourth intercostal space, where you stopped, just to the side of the sternum. This is lead V1.
8. At the same level as V1, on the opposite side of the sternum, place another dot in the fourth intercostal space of the subject’s left side. This will be lead V2.
9. Remaining on the left side of the chest, count down one more intercostal space. Place your left index finger here.
10. Locate the subject’s left clavicle, and approximate the middle of it.
11. Move your left index finger, which is in the intercostal space, so that it is in line with the middle of the subject’s left clavicle. Using your marker, place a dot at this site. This is lead V4.
12. Locate the two dots on the left side of the chest (leads V2 and V4). At a diagonal line, place a dot in the middle of these two dots. If this dot is on top of a rib, move the dot down, just below it. This is Lead V3.
13. Have the subject stand, so that their left side is facing you. Have them raise, their left arm straight out, and above their head.
14. Locate the mid line of the arm pit. Staying on this mid line, place a dot at the same level as lead V4, on this mid line. This is Lead V6.
15. Locate the dots for Leads V4 and V6. Place one more dot, at the same level as these two, in the middle of them. This is Lead V5.
16. Using a mildly abrasive gel that will probably be provided, place a small amount on each of the ten dots that you just made.
17. Using a damp towel, remove the gel from each of the ten sites. Towel dry each of the sites afterward.
18. Place an electrode at each of the ten, now clean, areas.
19. Depending on the computer setup, hook each of the electrodes to the computer via the provided lead wires. Make sure to place the right lead wire to the specific area that it is designated to.
20. Have subject perform stress test on the treadmill.

Tips

• When removing the mildly abrasive gel, the area on the skin should appear slightly pink in color.