Abstracts

Rationale: Children undergoing video electroencephalogram (EEG) monitoring are at risk for pressure ulcers or skin abrasions secondary to electrode application and usage. With increasing use of continuous EEG monitoring in pediatric and neonatal intensive care units there is even greater concern for skin breakdown in these populations. We developed a protocol for electrode application and maintenance to reduce the incidence of these complications.  The primary objective of our study was to assess skin complication occurrence after protocol implementation.  Methods: This study is a retrospective review of all children who underwent critical care electroencephalogram (ccEEG) or long term monitoring (LTM).  Baseline data on skin complications was collected from April 2016-August 2016. This data was used to determine a goal for skin complication reduction. Skin complication was defined as any breakdown in the skin barrier; redness of the skin was not included in this definition. Neurodiagnostic (NDG) technologists completed in-service training to standardize application of electrodes to best practice. This involved skin preparation with minimal scrubbing, in one direction only rather than circular or back and forth, cleaning Wave-prep from the skin with alcohol prep pads after preparation, application of Cavilon to exposed skin (including electromyography and electrocardiogram), use of Cover-roll stretch on skin surfaces as opposed to tape, and light wrapping of head with a Stockingette. Patients undergoing ccEEG monitoring had electrodes removed for a 2 hour skin break every 48 hours, followed by head/hair wash prior to electrode reapplication. From November 2016 through June 2017 NDG technologists tracked skin complications to measure the effect of the intervention.    Results: During the baseline period, 133 children underwent EEG monitoring (n=47 for ccEEG and n=86 for LTM) with a mean age of 7.33 years (SD = 6.11) and an average length of EEG recording of 1.99 days (SD = 1.93).  Skin complications occurred in 13.5% of patients in this cohort.  This led to an institutional goal of a 20% reduction in skin complications (a goal of 10.8%).  In the period after the intervention, 255 patients underwent EEG monitoring (n=95 for ccEEG and n=160 for LTM), with a mean age of 6.82 years (SD = 6.08) and an average length of EEG recording of 1.89 days (SD=1.54).   The rate of skin complications during this period was 7.1%. This was a reduction of 53%. Conclusions: This study demonstrates that employing best practices by NDG technologists with electrode application and allowing for skin breaks in the critically ill population can lead to an overall decrease in skin complications from EEG monitoring.  Funding: None.