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NICU guideline identifier

Brain monitoring in the neonate - Video aEEG

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Applying Electrodes

Equipment

  • 10 strips of zinc oxide tape cut in half,
  • duoderm and double sided tape, (there is a roll of this in the study bag) .Do not use Velcro patch as this has led to a pressure sore
  • alcohol wipes,
  • needle electrodes 10
  • gel electrodes 2 (in plastic bag on back of EEG machine, not the Brainz ones which are too short)
  • hypafix tape squares - for over 2 electrodes on the body and any extra head electrodes that need extra securing.
  • nuprep cream and cotton bud for preparing skin for the 2 gel electrodes,
  • pink or blue baby head wrap, BraiNet - (in plastic bag on back of EEG machine)
  • Oral sucrose ( if baby not receiving morphine)

Process

  1. Measure baby's head circumference to Select BraiNet based on head circumference measurement.
    (Baby BraiNet Size 2/ Small for head circumference 30-33 cm,
    Baby BraiNet Size 3/ Medium for head circumferences between 33.5-37cm,
    BraiNet Size 4/ Large for head circumferences between 37.5-41 cm,
    Baby BraiNet Size 5 for head circumferences between 41-45 cm)
  2. Put on BraiNet and fasten chin strap ensure chin strap is not causing respiratory compromise, strap should be loose.
  3. Secure the front and back of the BraiNet using duoderm on the skin and double sided tape on top of that, and stuck to the underside of the BraiNet.
  4. Locate the areas for electrode placement using the the BraiNet and Neonatal Montage picture. Do not place an electrode over an area of cephalohematoma or infection. Avoid the fontanelle and avoid insertion into visible veins in the scalp. In these situations place the electrode as close as you can to the suggested area safely.
  5. Oral sucrose just prior to insertion of the needles and swaddling should be used for pain relief. (If baby is being cooled and on morphine, this is an alternative pain relief.)
  6. 1 person holds the elasticated BraiNet out of the way, the other cleans with alcohol wipe then places needle subdermally and tapes with a loop of zinc oxide tape cut in half length wise. The elasticated BraiNet usually comes back down over the needle helping to secure it.
    NeoLev1
  7. Plug each electrode into the color coded jack box as you go.
  8. Start from the back of the head, O1 and O2 will be in the Blue BraiNet holes
  9. Place the blue or pink baby head wrap under the head to protect the leads
  10. Then place the other electrodes down one side of the head, left or right:
    • purple ((T3 ( purple left hole) or T4 ( purple right hole))
    • green (C3 ( green left hole ) or C4 ( green right hole))
    • red (FP1 ( red left) or FP2 ( red right hole))
  11. Pull the blue or pink baby head wrap up to protect that side of the head, turn head and place the electrodes on the other side of the head.
    • purple ((T3 ( purple left hole) or T4 ( purple right hole))
    • green (C3 ( green left hole ) or C4 ( green right hole))
    • red (FP1 ( red left) or FP2 ( red right hole))
  12. There are two more electrodes to place in the midline
    • Fz in the Grey (GND) hole ( or close to it)
    • Cz in the Black BraiNet hole ( or close to it)
     These midline electrodes are close to the fontanelle.
    Often the BraiNet circle will be right over the fontanelle, so if this happens adjust placement to just anterior and just posterior to the fontanelle in the midline.
    Aim the needle laterally from one side towards the midline and keep the needle angle flat to the skin, to stay superficial in the skin.
  13. In addition to the needle electrodes over the scalp, we will place 2 gel electrodes:
    • a Ground electrode- to be placed anywhere on chest
    • an EKG electrode- anywhere on chest
    These are the most difficult electrodes to place because it is difficult to get a good recording impedance.
    Prep the skin with nuprep on a cotton bud before sticking the electrode on. This does require moderately firm pressure with the cotton bud against the skin in order to get adequate impedance.
    When you place the sticky electrode on the skin, push it down firmly and keep pressure on it while covering it with a square of hypafix tape.
    Wrap the motion detector around any limb.

Removing electrodes at the end of a recording

  • All the electrodes are disposable. The priority is for staff not to get a needle stick injury.
  • Cut the electrodes in a bundle outside the headwrap, so there is less chance of entanglement.
  • Use "remove" to get the zinc oxide tape off the hair. This is ok for term babies and it doesn't come off easily!
  • Place each needle in some gauze or other form of pincushion as you remove them so there is less risk of needle stick injury.

Neonatal montage

Neolev montage

Turning the Computer On

Turn on

  • Press power Button (see arrow)

Open drawer

  • Open drawer to find remote input box and motion detector

Plug in remote

  • Plug in remote input box and motion detector to the bottom of the Jackbox

Starting a recording

NB. All steps below can done remotely by Dr Sharpe or Dr Davis once computer is on.

  1. Double click icon in the middle of the screen which says "Easy III Record Data"
    Easy record
  2. A box will open saying "Login ID Admin"
    Password- (blank)
    enter "Admin" in blank space
    Click OK
  3. List of already recorded EEG's will come up
    recorded eegs
    Click New Patient (see arrow)
    A window will open for you to enter a minimal data set
  4. Enter:
    Last name, first name
    Birthdate 05 06 2013 (need gap between day month year)
    Gender
    ID Number- ( not required)
    In Start Recording panel click button that says ICU
    start recording
    You will see a Message - your program is loading please wait
    Another window will open with more data fields- but you do not need to fill this in.
  5. Message
  6. Just Click OK . The main display window will open
    Click ok
  7. Press Imp (Impedance) to check impedances
    Press Imp
    Usually the needle electrodes all show excellent impedances <5
    Acceptable impedance is less than 10
    If the ground is over 10, try again to prepare the skin. Sometimes a bit more abrasion allows you to replace the old gel electrode and tape it down and achieve good impedance. If this is not successful try again with a new gel electrode.
  8. To start a recording press the Green Button
    green button
  9. To enter a comment use the comment button on the top right part of the screen
    comment
    Click the comment button you want, then click over the top of the eeg recording.
    (Clicking on the comment button repeatedly without then doing a second click over the EEG tracing will not do anything.)
    COM- select this button to enter free text comment
    PC- select this button to indicate you are touching the patient for Patient Cares
    Meds - select this button to indicate you are giving Medication
    ELEC- select this button to indicate you are fixing the electrodes
    ?SZ- select this button if you suspect the patient is having seizures
  10. If you review past sections of the recording, the screen will be frozen and you will not be viewing the live EEG.
    To get back to live review press View Live Data button at the bottom right of screen.
    It is small and hard to find, if you hover the mouse in this area at the bottom right part of the screen, when you are over the View Live Data button, those words appear.
    Live view
  11. Corticare Techs and Neurologists read the EEG remotely using Teamviewer software.
    They may ask you for the Teamviewer ID and password, so they can log in.
    Find and open the Teamviewer application by clicking on your multicolored START icon lower left corner and then selecting Teamviewer.
    team viewer software

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Document Control

  • Date last published: 28 May 2015
  • Document type: Clinical Guideline
  • Services responsible: Neonatology, Paediatric Neurology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years