Monthly Tips for Sleep Professionals
by Lee Payne, RPSGT
December 2007
Clean the wires thoroughly! A good rule of thumb is to ask yourself when you are finished if you would let a loved one be hooked up with these wires.
November 2007
Take some of the extra time during the night and make sure you are up to date on your facility’s policy and procedure manual. Being prepared for an emergency may give you the few extra seconds that is needed!
October 2007
It doesn’t cost extra to hook a patient up the proper way the first time. Take an extra minute to make sure you prep the areas properly. It will save you time by not having to enter the patient’s room later and will save the lab money by not having to use extra supplies.
September 2007 When doing the EEG, use the 10/20 system. Mark the spots on the head with a grease pencil. Make a "flower" with the conductive paste (use the paste and make a circle, starting from where you marked the spot, about a half inch in radius...this will make the whole spot about one inch in diameter). Gently scrub away the grease mark. Clean the area with gauze so it is not wet. After making the flowers on all 4 spots, start with the first flower you made and get a small scoop of conductive paste on your EEG lead (gold cup) and place it on the spot where you scrubbed and wiped. Move on to the next one and repeat until all 4 are finished. Then go back and place gauze that has a thin layer of conductive paste on top of the gold cup and gently press down around the area. Repeat this until all 4 eeg leads are complete.
This helps clean the area for better impedances and also helps hold the gold cup in place. It will keep you from having to enter the patient's room so often at night.
August, 2007: Thermistor flow should match the respiratory effort belts at all times unless the patient is having events. Placement is the key. When doing bio-cal, both the nasal breathing and oral breathing should match the respiratory effort belt signal. If the patient takes big breaths, respiratory channels and flow channels should show this. If the patient takes shallow breaths, the same principle applies. A good way to see if your flow is good is to use a view that is greater than 30 seconds and see if all the respiratory channels are matching. If you have a flow channel that is bad, it will not match the respiratory effort (assuming there are no events). If there appears to be OA's (obstructive apneas) and there are no desats occurring with them, make sure that the part of the thermistor that reads oral breathing is located properly. When the patient goes to sleep, the chin relaxes and it will change the way the flow signal reads.
July, 2007:
With the usage of computer based CPAP recordings, it is easier than ever to get a patient titrated properly. Be sure to step back and take a look at the recording from several views in order to see what’s going on during the night. It’s easy to miss hypopneas that last longer than 30 seconds when viewing a 30 second screen. Zoom out to a 5 minute screen and look for changes in respiratory patterns and adjust the CPAP pressure accordingly. Make sure to zoom back in so you can see the other portions of the recording clearly, as the 3 and 5 minute screens do not offer a clear view of the ECG and EEG channels. Many of the newer programs offer the ability to view the channels respiratory channels at one setting, and the EEG channels at another. Check your user manual to see what your software offers!
June, 2007:
When the patient lays down, check the chest and ab belts again. For the best signal pull the slack out from under the patient before tightening. This will help keep the signal strong when a patient lays in lateral positions and will also cut down on having to enter the patient's room as much. Make sure that you do not overtighten the belts as this can cause signal problems.
