# Pre-attached Electrodes



## mikie (Aug 17, 2011)

In recent threads about lead wires, etc, got me to thinking.  As a paramedic student & EMT, i have seen many different agency setups...My question is, do you pre-attach your electrodes to your leads?  I have seen both.  

I have heard anecdotes about reduced efficacy/_stickyness_ if you pre-attach them, at the same time, it seems like it saves time.

What is your practice?


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## Shishkabob (Aug 17, 2011)

Sometimes I do, sometimes I don't.  


Nothing is so time sensitive that I need an EKG 5 seconds sooner.


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## NomadicMedic (Aug 17, 2011)

I preload my electrodes. Both my regular ekg and my 12 lead cables. I use the monitor so often that they won't dry out. 


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- Sent from my iPhone.


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## jjesusfreak01 (Aug 17, 2011)

n7lxi said:


> I preload my electrodes. Both my regular ekg and my 12 lead cables. I use the monitor so often that they won't dry out.



Ditto...they're used multiple times each shift.


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## fortsmithman (Aug 17, 2011)

n7lxi said:


> I preload my electrodes. Both my regular ekg and my 12 lead cables. I use the monitor so often that they won't dry out.
> 
> 
> ---
> - Sent from my iPhone.



My service only does 3 lead.


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## Aidey (Aug 18, 2011)

n7lxi said:


> I preload my electrodes. Both my regular ekg and my 12 lead cables. I use the monitor so often that they won't dry out.



We do to. Our ambulance is in service 24/7 so chances are they are going to get used within a couple of hours.


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## MedicBender (Aug 18, 2011)

Every service I've seen has done this, IMHO its just less of a hassle


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## usalsfyre (Aug 18, 2011)

Old partner always did it (to her saves time) new partner never does (says they tangle easier). Really makes no difference to me.


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## NomadicMedic (Aug 18, 2011)

We restock at the hospital, so setting up the monitor leads with fresh electrodes, rebuilding the IV roll and getting replacement meds out of the Pyxis is the standard that we do after every call. I like knowing that I'm good to go after every call. 


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- Sent from my iPhone.


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## Melclin (Aug 18, 2011)

I always want them pre-attached.  

Its not a clinical thing. I'm just a clutz and anything that reduces the likelihood of me fumbling or dropping things in front of pt/family and making myself looking completely incompetent, the better. 

Also, it does save time. In concert with a bunch of other time saving measures, it adds up. Again, its not a clinical thing. Its about making things run smoother and more efficiently with sick patients. It boosts my own confidence, it makes a potentially stressful situation, less so, it makes me look better in front of CIs who have to report on my progress and has a subtle positive affect on the dynamics of a job.

I like it when I lay a pt on the stretcher, my partner closes the back doors and by the time they open the side door and hop in to help me, I've already done seven different things. Its adds to the feeling that they're working with someone who knows what they're doing.


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## JJR512 (Aug 18, 2011)

I've only been attaching monitor leads to patients for a short while, but having the electrodes pre-attached *makes me slower*. I find it to be both more difficult and more time consuming to detangle the leads when the electrodes are attached.

Almost all of the Paramedics I work with prefer to have them pre-attached.

The Maryland Medical Protocols actually addresses this, but only in a pilot protocol aimed specifically at EMT-Bs that allows them, with special permission, to acquire and transmit 12-lead ECGs in the abscence of ALS providers so the receiving hospital can be prepared for an AMI patient.


> Remove electrodes from a sealed package immediately before use.
> Using previously unpacked electrodes or electrodes with expired date​codes may impair ECG signal quality.


No other mention of removing electrodes from the package, or attaching them to the monitor leads, is mentioned anywhere in the protocols.


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## Sasha (Aug 18, 2011)

Nope. Unless we are picking up from a nursing home, if the patient needs a monitor chances are they are already on it. You just unsnap the tele and snap your leads on to the ones they're already wearing.


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## medicdan (Aug 18, 2011)

Sasha said:


> Nope. Unless we are picking up from a nursing home, if the patient needs a monitor chances are they are already on it. You just unsnap the tele and snap your leads on to the ones they're already wearing.



Ditto. We do mostly ALS IFT  (SCT), so we end up connecting to patients more often than applying electrodes to patients. We do keep the 12-lead cables pre-connected, though.


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## mikie (Aug 18, 2011)

JJR512 said:


> I find it to be both more difficult and more time consuming to detangle the leads when the electrodes are attached.


 
That's the problem I typically have with it; i find it easier to untangle wires w/o electrodes.  



JJR512 said:


> The Maryland Medical Protocols actually addresses this...



LOL of course, they address everything!


--

*My next question* for those that don't preattach their leads...

Do you place the electrode on the patient's skin first or on the lead?


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## usalsfyre (Aug 18, 2011)

Lead first, it often takes an uncomfortable amount of pressure to snap the lead on (or is darn hard due to adipose tissue).


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## medicdan (Aug 18, 2011)

mikie said:


> That's the problem I typically have with it; i find it easier to untangle wires w/o electrodes.
> 
> 
> 
> ...



I find if we reallocate the hospital's 5x2 electrode pad and pre-connect the leads they stay well organized... 






In general, I connect the lead to the electrode, then the electrode to the patient, when possible, to avoid pressing on their skin unnecessarily.


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## sir.shocksalot (Aug 19, 2011)

When I worked for a slow service we didn't because we would only do a 12-lead about once every 2 days, same with IFT. But on 911 we do a 12-lead several times a day so I try to pre-load the 12 lead so I don't have to spend 3 seconds snapping them together.


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## HotelCo (Aug 19, 2011)

sir.shocksalot said:


> When I worked for a slow service we didn't because we would only do a 12-lead about once every 2 days, same with IFT. But on 911 we do a 12-lead several times a day so I try to pre-load the 12 lead so I don't have to spend 3 seconds snapping them together.



If that three seconds actually means something for the patient, more than likely they're screwed either way. 


Sent from my iPhone using Tapatalk


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## HotelCo (Aug 19, 2011)

I don't pre attach them. Sometimes my partners do, and that's fine, as long as it doesn't become a tangled mess. 


Sent from my iPhone using Tapatalk


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## MrBrown (Aug 19, 2011)

We have a big plastic bag of stickies in the back of the Lifepak 12 so always attach new ones at the end of a job


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## CANMAN (Aug 20, 2011)

I am with that majority here. Pre-attached leads before everycall, at the decon and restock phase after every call. I don't appreciate much of a difference in the leads tangling with or without electrodes on them. To me it does save time, it may not be much but its one less thing I gotta mess with. If I want to do a 12 lead on a person the last thing I want to do is to have to snap on 10 leads. Everyone does things differently. 

When I was doing critical care full-time we used cable clamps for our lines, and our LP12 cables were kept in wire loom to prevent tangling. If you are running 6 channels at one yes thing are going to get tangled. In the industry I think most people understand transfering a patient that is critically ill, and moving them from a 3 foot wide hospital bed, and condensing all their interventions onto a 16 inch wide cot, there are gonna be some logistical issues. As long as there is clear communication and everyone takes there time in moving I have never had any issues. When people start to rush or there is a lack of communication thats where lines get pulled out etc.


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## johnrsemt (Aug 22, 2011)

At both my old services we preattached them;  but we would run 15 calls in a 12 hour shift.

  Here we don't   we may run 1 call every 2 months   depends on the trucks


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## sir.shocksalot (Aug 22, 2011)

HotelCo said:


> If that three seconds actually means something for the patient, more than likely they're screwed either way.


Oh, me pre-loading EKG electrodes has nothing to do with the patient, it's got everything to do with my sanity  . 3 seconds rarely means much for the patient, but that's about the length of my attention span


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## 325Medic (Aug 23, 2011)

At my full time job, it depends on what mood I am in or if my partner does it. At my part time job, it is always done and found myself preloading them this a.m. as a matter of fact. It really does not matter to me.

325.


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