Tessa Davis. Placement of ECG leads, Don't Forget the Bubbles, 2014. Available at:
In young children, the right ventricle normally extends to the right side of the sternum. To appropriately display right ventricular potentials, ECGs for children in the under five‐year age group must include an extra lead (‘V4R’) on the right side of the chest at a point analogous to the left sided V4.
- V4R: 5th intercostal space, right midclavicular line
- V1: 4th intercostal space, right sternal border
- V2: 4th intercostal space, left sternal border
- V3: use this lead for V4R, must label as such on ECG.
- V4: fifth intercostal space, right midclavicular line
- V5: anterior axillary line, same horizontal plane as V4
- V6: midaxillary line, same horizontal line as V4.
- Place on top part of arm or leg (less muscle interference)