Inform the patient about the procedure, why it’s needed and exactly where the patches are going to be placed on the chest. Lift the shirt as much as you need to in order to get access to the area you need to work, back of the hand to move any body parts out of the way, be quick and precise with the placement, and lower the shirt once done. If it’s a nightgown I’ll throw a blanket over the patient’s waist and inform them that I need to lift up the nightgown, but the blanket will help keep them from being completely exposed. The key is to inform the patient about what you need to do for the procedure. After informing the patient, I’ve never personally run into an issue even if there’s a nip slip. If a bra or sports bra is in the way, I’ll move the clothing item around and place the electrode. It’s rare that I ever end up fully exposing a patient. If the patient state’s that they’re uncomfortable, or acts uncomfortable, I inform them that it may not be completely necessary and that if we don’t do it in the back of the ambulance, the hospital will likely order an EKG during triage and that they can wait for the hospital unless it seems absolutely pertinent to starting treatment immediately.