Abstract 16195: Does Accuracy of V Lead Electrode Placement Differ Based on Gender of Patient: Results of the Practical Use of the Latest Standards of Electrocardiography (PULSE) Trial
Introduction: Proper placement of ECG monitoring electrodes is essential. Misplacement off the designated site can alter waveform morphology and lead to misdiagnosis of arrhythmias and ischemia. Studies have shown greater variability in placement of lateral chest electrodes (V4-V6) in females, particularly in older and larger women, as compared with males.
Purpose: To determine if there are differences in accuracy of the V lead electrode placement by gender.
Methods: The PULSE Trial is a 5-year, 3-phase, multi-site randomized clinical trial to evaluate the effect of the implementation of AHA practice standards for ECG monitoring on nurses’ knowledge, quality of care, and patient outcomes. The intervention consisted of an online ECG monitoring education program and strategies to change practice. We are reporting quality of care data for electrode placement using a 5-lead (Mason-Likar) electrode placement. Accuracy was dichotomized as either being placed in one of the correct V lead positions (V1, V2, V3, V4, V5, or V6) or not. Observations were made over 5 consecutive days at each of 3 time points (Time 1 Baseline, Time 2, Time 3) by 3 research nurses. Generalized linear mixed modeling with a random intercept for unit nested in hospital was used to account for intra-hospital and unit correlation.
Results: The sample contained 2,956 patients on cardiac units in 17 hospitals in the US, Canada, and China. The sample for this analysis was 42% female. Collapsing all 3 time points, accuracy of V electrode placement for men was 42.6% vs. 43.1% for women (p=.77). In multivariate analyses, adjusting for age, treatment group, and time, there was no significant difference in accuracy for V electrode between men and women (p=.58).
Conclusions: While accuracy of V lead electrode placement did not differ over time by gender, there is still room for improvement. With all 3 time points collapsed, <50% of men and women assessed had accurate electrode placement. The PULSE Trial reported significant improvement in accuracy of V electrode placement with implementation of AHA practice standards. Thus, education and strategies to improve accuracy of placement of V electrodes should continue without differentiation based on gender of the patient.
Author Disclosures: L.L. Davis: None. M. Funk: None. K.P. Fennie: None. J.L. May: None. K. Stephens: None. B.J. Drew: None.
- © 2016 by American Heart Association, Inc.