Proposed Bedside Maneuver to Facilitate Accurate Anatomic Orientation for Correct Positioning of ECG Precordial Leads V1 and V2: A Pilot Study The Journal of Emergency Medicine, 04/27/2012

Lehmann MH et al. – The H-N maneuver provides a primarily visual approach to identifying the second intercostal space (ICS) and, thereby, the fourth ICS for affixing V1–V2. If the present initial experience is confirmed, H-N might merit consideration as an educational tool to promote anatomically correct placement of these precordial leads, a prerequisite to diminishing the incidence of electrocardiogram (ECG) procedure–related “septal ischemia/infarction.”

• The evaluated technique involved placement of the patient’s hand up against the base of his/her neck (H-N maneuver) to help demarcate visually a specific point “X” on the chest.

• Of 112 patients studied, “X” landed on the first rib in 2.7%, first ICS in 7.1%, second rib in 56.3%, second ICS in 33.0%, and third rib in 0.9%.
• Thus, in 89.3% (95% confidence interval 83.6–95.0%) of cases (93.3% of men, 84.6% of women; p=0.13), the second ICS could be identified by H-N via the following simple rule: Utilize “X” if it overlies an ICS; or the immediately subjacent ICS if “X” overlies a rib.