olympic brainz monitor policy procedure

OLYMPIC BRAINZ MONITOR

POLICY The physician orders continuous Cerebral Function Monitoring (CFM) via Olympic Brainz Monitor (OMB) as an amplitude-integrated electroencephalography (aEEG) for infants greater than (>) 30 weeks gestational age with suspected neurological insult or impairment. Subdermal needle electrodes may be used on infants > 30 weeks gestation. Note: Subdermal needle electrodes are contraindicated in the event of coagulation abnormalities or hematoma. Subdermal needle electrodes are removed for an EEG. Applicability: aEEG using the Olympic Brainz Monitor occuring within the Neonatal Intensive Care Unit. PROCEDURE Gather Equipment for Hydrogel Sensors 1. Brainz™ Monitor 2. Olympic Brainz Monitor™ adapter set 3. Neonatal hydrogel sensors, 5 4. Standard tip skin marker, 1 (non-permanent marker) 5. Medicine cup

6. Nu Prep (skin prepping gel) 7. Razor 8. Sterile q-tips 9. Sterile water 10. Sterile 2x2 gauze

Gather Equipment for Subdermal Needles

1. Olympic Brainz Monitor™ Monitor 2. Disposable subdermal needle electrodes

#29 gauge, 4 3. Neonatal hydrogel sensor, 1 4. Standard tip skin marker, 1 (non-

permanent marker) 5. Dexidin 2 solution

6. Wrap hat 7. Medicine cup 8. Non-sterile gloves 9. Paper tape 10. Sterile cotton tipped applicators (q-tips) 11. Steri-strip™ 12. Sterile water 13. Sterile 2x2 gauze

Registered Nurse (RN) or Registered Respiratory Therapist (RRT) To apply Olympic Brainz Monitor monitoring the RN and RRT must have completed the competency review skills checklist.

Preparation Note 1. Check for physician’s order to initiate Cerebral

Function Monitoring

2. Plug in OBM at bedside OBM takes 15-20 seconds to startup

3. Select "patient" and enter patient information (Patient ID, Name and date of birth)

Ensures data stored for ease or printing and retrieval later

4. Assemble OMB monitoring equipment for hydrogel sensors or subdermal needles

Subdermal needle electrodes are contraindicated in the event of coagulation abnormalities or hematoma

5. Position infant supine with head in neutral position

Use second person or parents to provide developmental support for the infant

NN.03.03D Neonatal Program Policy & Procedure Manual Effective Date: Jun-09-2017 of 10

Refer to online version – Print copy may not be current – Discard after use


Preparation Note 6. Measure from the tragus to the midline of the

scalp (use sagittal suture to landmark the midline of the scalp).

Figure 1: Craniosynostosis (Source: Seattle Children’s Hospital)

Use large tape for full term infants Use small tape for premature infants Align strip so each end point has the same letter

(A, B etc) Ensure that the tape is parallel to the plane

of the face. Ensure the tape covers ear during

landmarking process

Ear tragus

7. Mark site for electrode placement with a non-permanent marker Use the same letter on the either side of the

scalp (e.g. if the infant is “C” on the left, keep it a “C” on the other side of the head)

Adjust OBM lead positioning to avoid haematoma or caput succedaneum

8. Mark size on the measuring tape Label tape with infant’s name

Adhere tape to the monitor indicating to the next nurse where the leads were placed

Procedure Note For Hydrogel Sensors: steps 9 to 19 For Subdermal Needles: steps 20 to 29

Hydrogel Sensor Setup 9. Do not shave head for Hydrogel Sensors Fine hair should not need to be shaved:

Part hair using a comb or toothbrush Shave only a small area at the site (if needed)

10. Cleanse the scalp with sterile water if dirty Infants with vernix or blood present in hair will require a comb to clean hair prior to sensor application

11. Cleanse the area with Nu Prep on a q-tip 12. Clean off Nu Prep with sterile water on sterile

gauze, while keeping the hair parted over site Never use normal saline as it will deactivate the hydrogel sensors

13. Pat area dry




Procedure Note 14. Part the hair if not done during cleaning 15. Place hydrogel sensor’s electrode circle on the

cleansed site Direct sensor wires upwards to the crown of

the head

16. Apply gentle pressure over sensor to facilitate adhesion

17. Repeat process for remaining sensors Ensure the 2 sensors on each side of the head do not touch each other

18. Place the reference sensor on the back, chest, or shoulder and attach to the green lead

Prep the skin for the reference sensor as for the hydrogel leads Check sensor quality on the Brainz monitor

throughout application Ground sensor drying out/poor adhesion can be

reason for poor signal quality Sensor indicators should be green

19. Place electrodes directly into the data acquisition box (DAB) follow the arrows on the diagram that

corresponds with the electrode positioning on the baby’s head

For Subdermal Needles: 20. Do not shave head for needle electrodes 21. Cleanse scalp with sterile water if dirty; use

comb on matted hair

22. Clean using Dexidin 2 solution with mild friction

Scrub scalp for 30 seconds Dry for 60 seconds

23. Insert the needles in the scalp in a horizontal position subdermally

24. Position the electrode anterior to posterior Electrode wires are directed upwards towards the




Procedure Note

top of the head

25. NEVER reinsert needle if it has been withdrawn from the skin

Do not insert needle into veins or hematomas 26. Secure needles with steri-strip™ at the

insertion site: Place steri-strip chevron to secure Place one small piece of paper tape over top of

chevron

27. Place the reference (ground) hydrogel sensor on the back, chest, or shoulder and attach to the green lead

NEVER use a needle as the reference sensor.

28. Prep the skin for the reference (ground) sensor: Cleanse the area with Nu Prep on a q-

tip Clean off Nu Prep with sterile water on

sterile gauze, while keeping the hair parted over site

Pat area dry Never use normal saline as it will

deactivate the hydrogel sensors Check sensor quality on the OBM throughout

application Sensor indicators should be green

Post Procedure Note 29. Check sensor indicators periodically

throughout monitoring to ensure green throughout OBM use

Green = OK, <10kΩ Amber = Marginal >10-20kΩ Red = Poor >20Ω

Poor signal will trigger Amber or Red indicatorsand an audible tone. Silence alert and troubleshoot cause.

To silence an alert when “Signal” button

flashing. Press “signal” button and select “dismiss” from the popup.

Always check the ground hydrogel sensor first;

this is often the problem, especially when all the other sensors are needle sensors.

30. Once all sensor indicators are green, initiate Brainz monitoring by pressing record




Procedure Note

31. Selects 3 electrode or 5 electrode

configuration

Monitoring/Marking and Printing Events 32. MD to Review OBM monitor tracing every 24

hours and complete an aEEG Checklist for OBM tracing for previous 24 hours.

Refer to aEEG Checklist, Appendix E To Print a report with selected aEEG tracings

see ‘Printing Events/Reports’ section

33. Continue Brainz monitoring for 5 days (120 hours) as per Physician’s Orders

Remove needle sensors carefully (to avoid a needle stick) and place in sharps container.

Marking Events Note Mark an event when providing care (e.g. administering phenobarbitol, suctioning, diaper changing) to an infant on OBM.

-

The marker will be placed at the current cursor timeline location.

Scroll through the recording to place markers retrospectively

Select “markers/add”: Select one of the preselected markers A red line will appear in the aEEG display (use the navigation controls and cursor to add a marker at a different spot along the timeline) Creating a Custom marker: Touch the custom marker field Type in the custom event name and press

“add”

Reviewing Events




Procedure Note When Marker has been placed a green marker line extends down from the event tag, through the aEEG and Impedance display

- Marker description is visible in top left - Marker time is noted on the bottom

Events triggered by the seizure detection software will appear as a redlines/blocks above aEEG tracing

Seizure Detection/ Background Pattern Alert When an area of suspicion is detected by the OBM the “Clinical” button will turn from green to red and begin to flash yellow/orange with audible tone. When a change in the background pattern is detected the “Clinical” button will change from Green to yellow/orange with no audible tone: 1. Notify MD 2. Place maker for event

Seizure detection= Tone + Visual (“Clinical” button flashing) Background Pattern= Visual (“Clinical” button flashing) To silence alert: Press “Clinical” button Select “Dismiss”




Procedure Note 3. Silence Alert 4. Document event Printing Events/Reports Creating a ‘Snapshot’:

Select the scoring view icon Select segment of interest Press “Report” button Label as appropriote Select “Save”

Events of significance are saved as ‘Snapshots where they can be copied to a USB key for printing

Printing a Single aEEG segment ‘Snapshot’: Select “reports” and select “snapshot” to

access the details page Select details to be included in snapshot

(Print Information, CFM Graph, EEG Graph, Impedance Graph, Marker Text)

Ensure USB is plugged in to the monitor Select save location “USB @ OBM..” Select “Copy” to save to the USB key Touch the HOME icon on the Main

Taskbar to return to live recording Remove USB Key from CFM monitor and

insert in printing enabled computer. Open USB file and print.

Printing Multiple ‘Snapshots’: Select “Patient”, select “snapshot” Press single file icon to change to

multi file select icon Select snapshots from list to include in report Press “Copy” to save to the USB key Select location from pop up window

Suspending/Powering off 34. Suspend the OBM if the infant is moved for a

procedure and Brainz monitoring will need to be re-started

Press the button and confirm suspend recording

Once Brainz is suspended data will be saved, do not unplug without first powering off

Brainz needles must be removed for an EEG to be performed




Procedure Note

35. To Power off OBM first select in the top left corner of the screen. Wait until the green signal light is dark before unplugging.

Never unplug the OBM without first powering down or this will cause damage the internal hard drive.

36. Remove hydrogel sensors or subdermal needles

Hydrogel sensors maybe attached to a piece of saran wrap to maintain moisture and reactivated later with sterile water

Subdermal needles are single use only must be disposed in sharps container after each use (always remove subdermal needles for EEGs)

37. To restart Brainz monitoring, repeat skin preparation for both the hydrogel sensors or subdermal needles

Press “restart” and “confirm” to restart monitoring

Documentation Nursing Flowsheet: Hematoma or caput succedaneum Type of electrodes applied Tolerance of the procedure Seizure log

DOCUMENTATION aEEG Checklist Bedside Information Tool (BIT) Nursing Flowsheet Seizure Log REFERENCES Olympic Brainz Monitor. Natus Medical. Retrieved November 13 2015, from http://www.natus.com/index.cfm?page=products_1&crid=778 Seattle Children’s Hospital. (2011). Retrieved from http://www.seattlechildrens.org/medical-conditions/bone-joint-muscle-conditions/craniosynostosis/

Back to Neurological Stabilization for HIE APPENDIX

A. aEEG Checklist B. aEEG Reference Patterns for Olympic Brainz Monitor C. OMB Quick Start Guide



http://www.natus.com/index.cfm?page=products_1&crid=778

http://www.seattlechildrens.org/medical-conditions/bone-joint-muscle-conditions/craniosynostosis/

http://www.seattlechildrens.org/medical-conditions/bone-joint-muscle-conditions/craniosynostosis/


Appendix B.

aEEG Reference Patterns for Olympic Brainz Monitor




NN.03.03D Neonatal Program Policy & Procedure Manual Effective Date: Jun-09-2017 of

10 Refer to online version – Print copy may not be current – Discard after use

olympic brainz monitor policy procedure

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