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You can help prevent skin breakdown!





Long-term monitoring in EEG is a growing field as we continue to push out from the typical hospital stay to being able obtain EEG data right in a patient's own home. With more patients being monitored long term (several days at a time) the concern for skin break down increases.


Skin breakdown is any kind of damage to the skin caused by friction, shear, moisture or pressure and is limited to the top layer of skin according to Children's Minnesota. An article pertaining to EEG electrode use and skin breakdown reported a 10-11.4% incidence of skin injury in pediatric populations, with a projected incidence from 25-35% for all EEG patients. Significantly higher risk of irritation was associated with electrode placement on the face and with four days or more of monitoring. ASET has done extensive research and reviewed the guidelines of the American Clinical Neurophysiological Society and International Federation of Clinical Neurophysiology to determine recommendations for skin breakdown prevention.


ASET found that even though the products of EEG such as electrodes, Nuprep, and collodion have an effect on skin breakdown, the concern is how these products are being used by the technologist applying the electrodes. The following list will give the recommended way to use products to avoid skin break down.

  1. Skin should be clean. Prep such as Nuprep or Lemon prep should be applied with a cotton tip applicator and applied with quick light strokes in only one direction.

  2. Disposable electrodes that are thinner and flat rimmed are recommended to create the least amount of pressure on the skin.

  3. When filling the electrode with conductive substance do not overfill, should be able to float the electrode over the prepared skin and have it stay without pressing hard on the skin.

  4. Electrode hub and tail should be cushioned with soft cotton or gauze where skin is exposed.

  5. Avoid blunt tip needles for filling if possible.

  6. Head wrap should be stretchable and breathable, two fingers should be able to fit under the wrap once placed.

  7. Impedances should be balanced and maintained up to 10 kohm for extended EEG.

  8. Develop a protocol for skin checks, during these checks some electrodes should be removed and skin integrity checked. If skin has breakdown electrode should be moved away from that site and electrodes should be adjusted for symmetry.

Skin breakdown is a major problem in EEG today, especially as more patients are exploring the options of long-term monitoring. By practicing these eight recommended techniques skin breakdown can be reduced, and ultimately provide a better experience for the patient.



Resources
Best practices - aset - the neurodiagnostic society. ASET. (2023, January 24). Retrieved March 20, 2023, from https://www.aset.org/best-practices/

MINOR SKIN BREAKDOWN. Children's Minnesota. (2019, March 8). Retrieved March 20, 2023, from https://www.childrensmn.org/educationmaterials/childrensmn/article/17891/minor-skin-breakdown/

Moura, L. M., Carneiro, T. S., Kwasnik, D., Moura, V. F., Junior, Blodgett, C. S., Cohen, J., McKenna Guanci, M., Hoch, D. B., Hsu, J., Cole, A. J., & Westover, M. B. (2017). cEEG electrode-related pressure ulcers in acutely hospitalized patients. Neurology. Clinical practice, 7(1), 15–25. https://doi.org/10.1212/CPJ.0000000000000312

Urrea-Mendoza E, Smith S, Eskew A, Hasegawa H, Hakimi A, Laforce L. Skin breakdown in electroencephalography (EEG), how often? How rare? Abstracts/Clinical Neurophysiology 129 (2018) e29-e30.
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