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EKG lead placement: 12-lead, 5-lead and 3-lead
For a 12-lead EKG, V1 goes at the 4th intercostal space right of the sternum, V2 at the 4th space left of the sternum, V4 at the 5th space in the midclavicular line, V3 halfway between V2 and V4, V5 at the anterior axillary line and V6 at the midaxillary line, level with V4. Four limb electrodes complete the 12 leads.
12-lead chest electrodes
| Lead | Placement |
|---|---|
| V1 | 4th intercostal space, right sternal border |
| V2 | 4th intercostal space, left sternal border |
| V3 | Halfway between V2 and V4 |
| V4 | 5th intercostal space, left midclavicular line |
| V5 | Left anterior axillary line, level with V4 |
| V6 | Left midaxillary line, level with V4 and V5 |
How to find the spots
- Find the angle of Louis (the bump where the top of the sternum meets the body of the sternum). The 2nd rib attaches there.
- Slide down to the 2nd intercostal space, then count down to the 4th space. Place V1 (right) and V2 (left) next to the sternum.
- Count down to the 5th space and place V4 at the midclavicular line.
- Place V3 halfway between V2 and V4.
- Place V5 and V6 in a straight line out from V4.
Limb electrodes and monitor leads
| Electrode | 12-lead | 5-lead monitor (US colors) | 3-lead monitor |
|---|---|---|---|
| White | Right arm | Below the right clavicle | Below the right clavicle |
| Black | Left arm | Below the left clavicle | Below the left clavicle |
| Red | Left leg | Lower left chest or abdomen | Lower left chest or abdomen |
| Green | Right leg (ground) | Lower right chest or abdomen | Not used |
| Brown | Chest leads | Chest, usually the V1 spot | Not used |
Mnemonics
- "White on right, smoke over fire": white on the right, black (smoke) above red (fire) on the left.
- "Snow over grass": white above green on the right side.
- "Chocolate close to the heart": brown goes on the chest.
Common mistakes
- Placing V1 and V2 too high (in the 2nd or 3rd space), which can change the waveforms.
- Placing electrodes over bone or a large amount of breast tissue. Place V4 to V6 under the breast when needed.
- Skin not prepped: dry, clean skin (and clipped hair if needed) gives a cleaner tracing.
NCLEX tip: Count intercostal spaces from the angle of Louis instead of guessing. Most 12-lead placement errors come from V1 and V2 being placed too high.
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Frequently asked questions
Where does V1 go on a 12-lead EKG?
In the 4th intercostal space at the right sternal border.
Where does V4 go?
In the 5th intercostal space at the left midclavicular line.
How many electrodes are in a 12-lead EKG?
Ten: six chest electrodes and four limb electrodes. Together they record 12 views (leads) of the heart.
Where are the 12 ECG leads placed?
A 12-lead ECG uses 10 electrodes: four limb electrodes and six chest electrodes. V1 and V2 go in the 4th intercostal space on either side of the sternum, V4 in the 5th space at the midclavicular line, V3 between V2 and V4, and V5 and V6 in line with V4.
How to remember lead placement?
For monitor leads: "white on right, smoke over fire" (white on the right, black above red on the left) and "snow over grass" (white above green on the right). For chest leads, count down from the angle of Louis to the 4th intercostal space for V1 and V2.
What does V1, V2, V3, V4, V5, V6 mean on ECG?
They are the six chest (precordial) leads. Each looks at the heart from a different spot across the front and left side of the chest: V1 and V2 near the septum, V3 and V4 over the front wall, and V5 and V6 over the lateral wall.
Keep studying
Sources
- Electrocardiogram, StatPearls, NCBI Bookshelf
- Recommendations for the Standardization and Interpretation of the Electrocardiogram, Part I, Circulation (American Heart Association), 2007
For study only, not medical advice. Ranges and protocols vary by facility; follow your program, your facility's policies and the provider's orders.