Patient Hookup Procedures Flashcards
What to bring
-Bring and take all of your regular prescribed medications according to your physician’s instructions.
-Bring sleeping clothes such as pajamas or shorts and a t-shirt.
-Bring a favorite pillow or blanket if desired.
-Bring any other specialty items you may need for sleep or will need first thing in the morning such as toiletries, toothpaste, toothbrush, hair dryer, etc.
What to do before arriving for the study
-Try to avoid naps during the day so that going to sleep will be easier during your study.
-Wash and dry your hair before going to the clinic. Do not apply sprays, conditioners, gels, or oils to your hair. There are a number of electrodes that will be attached and these substances can adhere equipment difficult.
-Remove nail polish from middle fingers. You will be wearing a pulse oximeter on one middle finger.
-Have your evening meal prior to showing up for your study. -Try and avoid eating or drinking anything with caffeine a few hours before your study. If possible, avoid caffeine after your lunch.
-Notify the sleep clinic if you need to come in early or show up later (most clinics ask you to be there around 7:30 p.m. to 8:00 p.m.) so that you can better be accommodated.
-Let the clinic know ahead of time if you have any special needs (e.g. trouble getting in/out of bed, any physical limitations, nocturnal enuresis, impairments, etc.)
What to do upon arrival and what to expect
•When you arrive, a sleep technologist will ask about your sleep habits. There will be a questionnaire for you to fill out.
• You will have some time to make yourself at home. There will not be any other patients in your room.
• Notify your sleep tech of any prescription medications and recreational drugs you take (be as honest as possible for best results).
• If your physician prescribes a sleep aid for the night of the study, ask the technologist when to take it.
• You’re going to be hooked up to a lot of electrodes that takes about an hour to apply. Please be patient and take direction from your technologist.
• Sleeping with a lot of electrodes can be a little uncomfortable, but your technologist will do everything they can to make you as comfortable as possible.
• Your technologist will monitor the study from another room, but you will have an intercom next to your bed if you need to contact them anytime during the study.
• Your results will not be ready the following day. Both the technologist and the sleep physician will need to interpret the study’s data. You should receive your results in approximately within 5-7 days.
Prior to patient arrival, sleep tech must:
- Arrive at the Sleep Center or lab earlier than the pts. (6:30PM for adults, 5:30PM for pediatric pxs)
- Verify order
- Review patient information
- Ask px’s medications (Insulin infusion, Nasal decongestants, Asthma or heart medications)
- Prepare the questionnaires (Berlin Questionnaire, STOP-BANG questionnaire or any hospital based assessment)
MATERIALS
Scissors, tape measure, EEG marker, medical tape, cotton-tip swabs, gauze 2x2 squares, conductive paste, EEG electrodes (gold cup)
Soft palate, uvula,
fauces, and tonsillar
pillars are visualized
Class I
Soft palate, uvula,
and fauces, seen-
tonsillar pillars not
visualized
Class II
Only base of uvula
visualized
Class III
Uvula not visualized,
no structures seen-
only soft tissues
Class IV
________ developed the international 10/20 electrode placement system in ____ as a standard measurement tool for placing electrodes on the head for recording electroencephalograms (EEGs).
Dr. Herbert H. Jasper / 1949
This system of measurement uses anatomical features such as the ____ and the _____ as landmarks to begin measurement.
ears / bridge of the nose
_____ are then found by measuring distances between these landmarks and using percentages of those distances rather than specific lengths.
Electrode sites
When measuring for a full EEG hookup, as many as ______ sites may be used.
256 electrode
for a standard sleep study, only ______ sites are used for exploring electrodes, and another ______ sites are used as references or ground, depending on the type of equipment used.
six electrode / three or four
When measuring for electrode placement for a standard sleep study, the _____ recommends the following electrode sites: ______ (often used as ground and main reference)
American Academy of Sleep Medicine (AASM) / F3 , F4, C3, C4, O1, O2, M1, M2, Cz, Fz, or Fpz
Step 1: Locate the Four Landmarks. The EEG measurement process begins by locating four landmarks on the head:
- Nasion
- Inion
- Left pre-auricular point
- Right pre-auricular point
The ______ leads are placed 1 cm laterally and 1 cm up or down from the outer canthus.
electrooculogram (EOG)
The ____ is the corner of the eye, or the point at which the eyelids meet.
canthus
The recommended placement for adult patients is to place the ______ 1 cm laterally and 1 cm up from the right outer canthus, and the ______ 1 cm laterally and 1 cm down from the left outer canthus. These are both referenced to the same lead, usually ____.
right EOG (termed E2) / left EOG lead (E1)
M2
In children, the EOG electrode placement may be reduced to _____ laterally on each side because of the smaller size of the face.
0.5 cm
The ____ channels used in polysomnography have bipolar derivations in that the signal is derived from two active (exploring) electrodes.
Chin Electromyogram (EMG)
To record muscle activity at the chin, ______leads are placed.
three chin electromyogram (EMG)
The first lead is placed in the middle of the chin, _____
1 cm above the inferior edge of the mandible.
The other two are placed below the ______ (EMG)
inferior edge of the chin.
One should be placed 2cm down and 2cm to the left of the midline, and the other 2 cm down and 2 cm to the right of the midline.
Chin Electromyogram (EMG)
Chin Electromyogram (EMG)
For pediatric patients, the measurements are often reduced to ____
above and below the mandibular edge and ___ to the right and left of the midline.
1 cm
Two _____ —a thermal device and a pressure transducer cannula—are placed directly in front of the nose and mouth.
airflow sensors
These devices detect airflow from both the nose and the mouth.
Two airflow sensors / airflow sensors
The ________ is usually placed directly on the center of the patient’s throat
snore sensor or microphone
______ detect the sound of the snore and should be placed at a location where the snoring can be heard.
Snore microphones
Sleep study montages must use at least a
single channel, two-lead electrocardiogram (ECG).
The ___ provides a display of the electrical activity of the heart. In a two-lead ECG hookup, one lead is placed directly under the _______ and the other is placed on the _______
ECG / middle of the right collarbone / lower left side of the ribcage.
The exploring electrode is the lead on the ______ , and the reference is the lead on the ______.
lower left / upper right collarbone
An additional ECG lead may be placed under the _______. This can serve as a backup electrode should one of the other two become dislodged during the study.
middle of the left collarbone
Using _______ provides the opportunity to display two additional waveforms of the heart rhythm ( _______ ).
three electrodes (leads I and III)
All three waveforms will portray ____ and _____ in patients with normal heart rhythms.
upright p waves, QRS complexes, and T waves
Two electrodes are placed on the outside of the lower half of each leg.
Leg EMG Leads
_____ are placed on the outside of the lower half of each leg.
Two electrodes
Specifically, they should be applied to the middle of the anterior tibialis muscle so they are 2–3 cm apart.
Leg EMG Leads
Foot and leg movements are best detected from this muscle.
Leg EMG Leads
Detection of _____ is most commonly accomplished with the use of effort belts that are stretched around the chest and abdomen.
respiratory effort
can be observed directly or may be monitored by a body position sensor.
Positional Therapy Belt
it should be clipped onto the thoracic respiratory belt
Positional Therapy Belt
The _____ for the oximeter is placed on the tip of any of the three middle fingers.
finger sensor
On one side of the device is a ____; on the other side is a _________. These two must be aligned with each other, on opposite sides of the fingertip.
red light / sensor that reads the red light
Any _____ should be removed because it can inhibit the oximeter’s ability to accurately detect the oxygen level in the blood.
fingernail polish
Following are helpful strategies that many technologists have found helpful in the patient hookup process.
> Antiperspirant
Ponytailing
Patient Questionnaires
Positive Airway Pressure Desensitization
ESSS
Electrodes in a Standard Sleep Study
