Which lead is best to monitor a patient?

Question

Quizplus · Accepted Answer

The selection of an electrocardiographic monitoring lead is not a decision to be made casually or according to habit.The monitoring lead should be chosen with consideration of the patient's clinical condition and recent clinical history.If the monitored heart has a normal electrical axis,lead II displays a waveform that is predominantly upright,with a positive P wave and positive QRS waveform.P waves are usually easy to identify in lead II,and it is recommended for monitoring of atrial dysrhythmias.However,it is difficult to identify right bundle branch block (RBBB)and left bundle branch block (LBBB).Lead V1 is the optimal lead to select if the critical care nurse needs to analyze ventricular ectopy.V1 provides information to facilitate differentiation between RBBB versus LBBB pattern or distinguish between ventricular tachycardia and supraventricular tachycardia with aberrant conduction,determine whether premature ventricular contractions originate in the right or left ventricle,and clarify when ST segment changes are caused by the RBBB and when they are the result of ischemia.Lead V1 is excellent for this purpose.MCL1 is an uncommon lead choice today.It is used only if monitoring with a three-lead system such as on a transport monitor.

Which Lead Is Best to Monitor a Patient