Accuracy and knowledge in 12-lead ECG placement among nursing students and nurses: a web-based Italian study Accuracy and knowledge in 12-lead ECG placement

Main Article Content

Noemi Giannetta
Giuseppe Campagna
Flavio Di Muzio
Emanuele Di Simone
Sara Dionisi
Marco Di Muzio


Electrocardiography, ECG lead placement, clinical skills, delivery of care, nursing education


Background and aim: Electrocardiogram (ECG) is considered the most used diagnostic tool to identify many cardiological disease and conditions that require the monitoring and recording of heart’s electric activity. The aim of this study is the validation and application of a web-survey, addressed to nursing students and nurses, in order to evaluate the degree of accuracy and the knowledge on the correct positioning of the 12-leads ECG. Methods: The study was a cross-sectional questionnaire-based study. The survey comprised 30 items, mainly multiple-choice questions.  The participants were 484 nurses and nursing students. In the study, no exclusion criteria were adopted, but fill in the questionnaire any nurse on duty during the data collection period and/or any nursing student during the data collection period. Statistical analyses were performed using the SAS v. 9.4. In the study, no exclusion criteria were adopted. Results: A total of 484 nursing students and nurses comprising of 149 males (30.79%) and 335 females (69.21%) responded. In full findings showed good psychometric properties and good reliability. The Cronbach’s alpha coefficient for the study is 0.76 (number of items = 17, number of obs= 484). The mean age of responders was 32.01 (Standard deviation (SD) 9.63). A logistic multivariate regression demonstrated significant differences. Conclusions: It is evident from our findings and those from other countries, that more education is required to ensure that mistaken interpretation, misdiagnosis, patient mismanagement and/or inappropriate procedures due to 12 leads ECG misplacement does not occur.


Download data is not yet available.
Abstract 1083 | PDF Downloads 452


1. Green GB and Hill PM. Cardiovascular Disease: Approach to chest pain in: Tintinalli JE, Kelen GD and Stapczynski JS: Textbook of emergency medicine, 2004.
2. Wilson F, Kossman C, Burch G et al. Recommendations for standardization of electrocardiographic and vector cardiographic leads. Circulation 1954; 10: 564–73
3. Khunti K. Accurate interpretation of the 12-lead ECG electrode placement: A systematic review. Health Education J 2014; 73(5): 610-623.
4. Mann DL, Zipes DP, Libby P, et al. Braunwald's Heart Disease E-Book: A Textbook of Cardiovascular Medicine. Elsevier Health Sciences, 2014.
5. Medani SA, Hensey M, Caples , et al. Accuracy in precordial ECG lead placement: improving performance through a peer-led educational intervention. J Electrocardiol 2018; 51(1): 50-54.
6. García‐Niebla J, Llontop‐García P, Valle‐Racero JI, et al. Technical mistakes during the acquisition of the electrocardiogram. Ann Noninvasive Electrocardiol 2009; 14(4): 389-403.
7. McCann K, Holdgate A, Mahammad R, et al. Accuracy of ECG electrode placement by emergency department clinicians. Emerg Med Australas 2007; 19(5): 442-448.
8. Di Libero J, Desanto-madyea S, O’Dongohue S. Improving accuracy of cardiac electrode placement: outcomes of clinical nurse specialist practice. Clin Nurse Spec 2016; 30(1): 45-50.
9. Finlay DD, Nugent CD, Nelwan SP, et al. Effects of electrode placement errors in the EASI-derived 12-lead electrocardiogram. J Electrocardiol 2010; 43(6): 606-611.
10. Di Muzio M, Dionisi S, Di Simone E, Cianfrocca C, Di Muzio F, Fabbian F, Barbiero G, Tartaglini D, Giannetta N. Can nurses’ shift work jeopardize the patient safety? A systematic review. Eur Rev Med Pharmacol Sci 2019; 23 (10): 4507-4519.
11. Di Simone E, Giannetta N, Spada E, et al. Prevention of medication errors during intravenous drug administration in intensive care units: a literature review. Recenti Prog Med 2018; 09(2): 103-107.
12. Di Simone E, Giannetta N, Auddino F, et al. Medication errors in the emergency department: Knowledge, attitude, behavior, and training needs of nurses. Indian J Crit Care Med 2018; 22: 346-52.
13. Di Muzio M, De Vito C, Tartaglini D, et al. Knowledge, behaviours, training and attitudes of nurses during preparation and administration of intravenous medications in intensive care units (ICU). A multicenter Italian study. Appl Nurs Res 2017; 38:129–133;
14. Di Muzio M, Marzuillo C, De Vito C, et al. Knowledge, attitudes, behaviour and training needs of ICU nurses on medication errors in the use of IV drugs: a pilot study. Signa Vitae, Int J Crit Care Emerg Med 2016; 11(1): 182-206;
15. Di Muzio M, Tartaglini D, De Vito C, et al. Validation of a questionnaire for ICU nurses to assess knowledge, attitudes and behaviours towards medication errors. Ann Ig 2016; 28(2):113-121
16. Giannetta N, Cianciulli A, Dionisi S, et al. Farmaci orfani: uno sguardo sulle politiche di produzione e ricerca in ambito europeo [Orphan drugs: an overview of production and research policies in Europe]. Giornale Italiano di Farmaci Clinica (GIFC) 2019; 33(1):29-34.
17. Di Muzio M, Reda F, Diella G, Di Simone E, Novelli L, D’Atri A, Giannini A, & De Gennaro L. Not only a problem of fatigue and sleepiness: changes in psychomotor performance in italian nurses across 8-h rapidly rotating shifts. Journal of clinical medicine 2019; 8(1): 47;
18. Di Simone E, Di Muzio M, Dionisi S, Giannetta N, Di Muzio F, De Gennaro L, Orsi GB, & Fabbian F. Infodemiological patterns in searching medication errors: relationship with risk management and shift work. European review for medical and pharmacological sciences 2019; 23: 5522-5529;
19. Márquez-Hernández VV, Fuentes-Colmenero AL, Canadas-Nunez F, Di Muzio M, Giannetta N, & Gutierrez-Puertas L. Factors related to medication errors in the preparation and administration of intravenous medication in the hospital environment. PloS one 2019; 14(7): e0220001.
20. Rajaganeshan R, Ludlam CL, Francis DP, et al. Accuracy in ECG lead placement among technicians, nurses, general physicians and cardiologists. Int J Clin Pract 2008; 62(1): 65-70.
21. Crawford J, & Doherty L. Ten steps to recording a standard 12-lead ECG. Practice Nursing 2010; 21(12): 622-630;
22. Cronbach, LJ. Coefficient alpha and the internal structure of tests. Psychometrika 1951; 16(3): 297-334.
23. DeVellis RF. Scale development: Theory and applications. Sage publications, 1991.
24. Nunnally JC. Psychometric theory (2nd edit.). Mcgraw-Hill. Hillsdale NJ, 1978; 416.
25. Bickerton M and Pooler A. Misplaced ECG electrodes and the need for continuing training. Br J Cardiac Nurs 2019, 14(3): 123-132.
26. Saadat H, Tajdini H, Saadat Z, et al. Is It Time to Review our Educational Program for the Electrocardiography Operators? Int J Cardiovasc Practice 2017, 2(3): 55-56.
27. Jeffries PR, Woolf S and Linde B. Technology-based vs. traditional instruction: A comparison of two methodsfor teaching the skill of performing a 12-lead ecg. Nurs Educ Perspect 2003; 24(2): 70-74.

Most read articles by the same author(s)