Download Introducing Bedside Continuous Electroencephalography

Introducing Bedside Continuous Electroencephalography Monitoring in
a Non-Neuro Intensive Care Unit
Sarah Crowe, RN, MN, CNCC(C); Caroline Penner, RN, CNCC(C); Judi Ku, RN, BsN
Surrey Memorial Hospital Intensive Care Unit, Fraser Health Authority, BC
Overview
Technology in critical care is constantly
changing and evolving. The use of bedside
continuous electroencephalography (cEEG) is
one example of evolving technology that can
have a considerable impact on critical care
patients. Bedside cEEG monitoring can be
used to provide information on the status of the
brain in real – time, allowing critical care nurses
to assess their patients’ level of consciousness,
and to monitor the effects of therapy, such as
sedatives. Bedside cEEG monitoring can also
be used by the interdisciplinary team to detect
and manage seizures, and to provide additional
data for prognostication when planning goals of
care for patients with brain injuries (e.g. postcardiac arrest, anoxic brain injuries, etc.).
Although cEEG is traditionally implemented
in intensive care units that specialize in
neurology, this technology was implemented in
our twenty bed medical – surgical intensive
care unit in order to provide our clinicians with
tool to improve patient care. We utilized a four
channel bedside GE EEG module with a sub hairline montage to accomplish this in
partnership with GE Healthcare and clinical
experts from across Canada. The purpose of
this presentation is to describe the process
undertaken to implement this technology
including planning, implementation, as well as
lessons learned for the future.
Clinical Background
Similar to other physiological vital signs (blood
pressure, heart rate and rhythm, oximetry,
temperature, etc…), EEG is a tool for
monitoring what is occurring in the brain.
Implementation
Our ICU team , with support from GE
HealthCare, facilitated bringing cEEG experts
from London Health Sciences Center, to our
center to provide education and hands on
training with our staff. Point of care ICU nurses
with an interest in technology and interested in
being a primary user where invited to a half day
training event, along with three physician
champions. An overview of the benefit cEEG
would bring to our critical care population,
intended uses, and challenges were all
discussed. The session concluded with hands
on application and practice on staff volunteers.
Monitoring electrical activity in the brain can
assist with:
• Detection and management of seizures
• Assessment in level of consciousness
• Monitoring the effects of therapy (e.g.
sedatives)
• Help provide prognosis planning (e.g. post
cardiac arrest / anoxic brain injury patients).
It is not unusual for patients who are comatose
or who have a decreased level of
consciousness to have sudden posturing,
rigidity, tremors, chewing, or changes in heart
rate and blood pressure without any
explanation. Bedside cEEG can help determine
the causes of such symptoms.
To date we have successfully utilized cEEG in
our ICU to monitor patients:
• With continuous seizure activity
• To titration medications in patients otherwise
unable to communicate effect
• For anoxic brain injured patients as another
sources of information aide families in
planning direction of care
cEEG tracing
References
Challenges
(Sample abnormal EEG)
Successes to Date
Personnel Challenges:
• RN training, understanding, and
interpretation of EEG waveforms
• Availability of EEG experts (technologists
and physicians) to aid in trouble – shooting
and interpretation
Environmental Challenges:
• EEG is very sensitive to electrical
interference
• ICU has many sources of electrical
interference / artifact
For more information please contact: Sarah Crowe ([email protected])
Harris, C. (2014). Neuromonitoring indications
and utility in the intensive care unit. Critical
Care Nurse, 34(3), 30 – 40.
Hirsch, L.J. (2004). Continuous EEG monitoring
in the intensive care unit: an overview. Journal
of Clinical Neurophysiology, 21(5), 332 - 340.
Rossetti, A.O, Urbano, L.A., Delodder, F.,
Kaplan, P.W. & Odder, M. (2010). Prognostic
value of continuous EEG monitoring during
therapeutic hypothermia after cardiac arrest.
Critical Care, 14(5), R173
Vespa, P.M., Nenov, V., & Nuwer, M.R. (1999).
Continuous EEG monitoring in the intensive
care unit: early findings and clinical efficacy.
Journal of Neurophysiology, 16(1), 1 - 13
Young, G.B., Sharpe, M.D., Savard, M.,
Thenayan, E.A., Norton, L., & Davies-Schinkel,
C. (2009). Seizure detection with a
commerically available bedside EEG monitor
and the subhairline montage. Neurocritical
Care, doi: 10.1007/s12028-009-9248-2