Dysrhythmia Monitoring

Select the best monitoring leads for dysrhythmia identification (display 2 leads when possible).

Lead V₁ to diagnose wide QRS complex.

Lead II to diagnose atrial activity and measure heart rate.

Proper electrode placement is required for accurate diagnosis (see FigureF1).

Prepare the patient’s skin before attaching ECG electrodes.

Measure QT interval and calculate QTc using a consistent lead if high risk for Torsades de Pointes.

Studies show that nurses often monitor in a single lead regardless of diagnosis.^1,2 

Failure to properly prep skin prior to electrode placement may cause inappropriate monitoring alarms.^3,4 

When an electrode is misplaced by as little as 1 intercostal space, QRS morphology can change and misdiagnosis may occur (ie, ventricular tachycardia [VT] may be misidentified as supraventricular tachycardia [SVT] or vise versa).⁵ 

V₁ is...