If the disposable electrodes won't adhere to the skin because of excess hair, diaphoresis, or oily skin, shave or clip the hair and wipe the skin with a gauze pad. Apply a fresh electrode to the prepared site. If the electrode requires gel, always use ECG conductive gel, not other nonconductive lubricants. Allow a short time for the tab to stabilize. Apply the electrodes sequentially, and make sure the wires aren't pulling on them.
Place electrodes on fleshy areas and avoid bony prominences.
If the patient is thin, you might have to vary the sites slightly to keep electrodes off the ribs. For a woman with large breasts, place V 3 on the breast and V 4 through V 6 below the breast. If your patient has a mediastinal chest bandage, V 1 and V 2 may be inaccessible. Place each electrode as close to the proper location as possible. Make a notation on the 12-lead ECG paper that electrode placement was modified because of the surgical dressing.