No Blunt Needles Allowed! What's a Tech to Do?
Keeping Up-to-Date with Changing Protocols
By Melissa Burke, R. EEG/EP T., CNIM
EEG technologists are frequently sharing new ideas and techniques with each other via social media groups to keep pace with ever-changing guidelines and best practices. It’s great to see seasoned techs and those newer to the profession exchanging ideas and supporting continuous learning.
A recent social media post caught my attention and posed the question:
“If we can no longer use blunt needles to insert conductive gel into electrodes on a long-term monitoring patient for daily maintenance, what should we be using? I hate to undo each electrode placement to add electrode paste. It was so much easier to use the blunt needle to insert the gel and not to scratch the scalp to improve impedances. Any ideas?”
This question sparked surprise from techs not familiar with the new guideline, as well as great feedback from others sharing alternate methods to fill the electrode cup with paste without using a blunt-tip needle. Collodion application techniques have included the use of blunt-tip needles for decades; in the past, it was the gold standard.
In 2017, ASET developed a position statement titled, “Skin Safety during EEG Procedures - A Guideline to Improving Outcome”. It discourages the use of blunt-tip needles during electrode application and re-gelling.
The following excerpts are from the ASET position statement:
- If using collodion-applied electrodes with a thin conductive agent, take caution when filling the electrode cup. A blunt needle tip can easily over-abrade the skin, causing injury to the skin surface.
- The Skin Safety Task Force collected data, which strongly discourages the following techniques:
- Non-breathable tape
- Tight head wraps
- Prolonged recordings, over 48 hours, with no skin integrity checks
- Blunt-tipped needles to reduce applied electrode impedance
In accordance with the recently revised ACNS guidelines, it is the recommendation that impedances be balanced and maintained up to 10 kilo ohm for extended EEG recordings to help maintain skin integrity.
The techs in the Facebook group shared the following tips and new techniques. These may be useful for you and your team when considering the best method to follow to maintain skin safety and obtain good EEG recordings. Always refer to your facility’s guidelines and protocol when considering new techniques.
Instead of using blunt-tip needles to fill the electrode cup or abrade the skin, these suggestions are offered following head measurement and skin prep during electrode application:
Method 1. “Float” the electrodes with Ten20® Conductive Paste
- Fill the electrode cup with a small cushion of Ten20 Gently adhere the paste-filled cup onto the scalp, preventing the electrode from touching the skin by “floating” on the paste. Do not press too firmly so that you squeeze all the paste out of the cup.
- Use collodion or tape to secure the electrode to scalp.
Method 2. Use either a 3cc, 10cc, or curved-tip syringe with Elefix®
- Use tape or gauze dipped in collodion to secure electrode to scalp.
- Use an electrode applicator stylet (Fig. 1) to make a hole in the gauze or tape over the hole in the electrode cup.
- To fill the syringe with Elefix, remove the plunger, and fill with paste using a tongue depressor. If the nozzle of the Elefix tube fits into the base of the syringe, you can squeeze the paste directly into the syringe.
- Hold the syringe perpendicular to the scalp, aligning the tip directly over the electrode hole, or insert the curved tip of the irrigation syringe (Fig. 2) into the hole. Dispense Elefix until the electrode cup is filled.
Method 3. Use EC2® Electrode Cream as an adhesive
- Fill the electrode cup with conductive paste, and attach it to the electrode site.
- Run a thin strip of EC2 on a gauze square (woven holds better than non-woven) or the sticky side of the Cover-Roll. Position the EC2 cream directly over the top of the electrode, and press onto the scalp. The EC2 will dry in 10-20 minutes, encasing the electrode and securing it to the scalp.
Re-gelling or replacing the electrodes
- Use syringe filled with paste (no blunt tip), and place perpendicular to electrode hole, and fill cup.
- If electrodes are secured with collodion, place acetone on cotton-tipped applicator and apply to a corner of gauze or tape. Carefully lift up electrode, add more paste, and then add a drop of collodion to re-attach.
- If impedances are high, remove the electrode per lab protocol. Re-prep with skin prep, and re-apply using method of choice.
Wrapping the patient’s head after electrode hook up helps ensure the electrodes remain in place and are less likely to be compromised by movement, etc.
Important tips from this article:
- Blunt tips are discouraged during electrode application and during repairing electrodes.
- The skin can be accidently over-abraded, which can cause skin irritation, breakdown, or infection.
- The longer the recording, the higher the risk of skin issues.
- Use the electrode applicator stylet to make a hole in tape or gauze instead of a blunt-tip needle (Fig. 1).
- If you are not using collodion and just using tape, you can still use the stylet to make a hole in the tape. No air compressor needed in this case.
- Different syringe sizes are preferred between users; decide which size works best for you.
- Elefix is easier to squeeze in and out of syringes, due to its consistency.
- EC2 can be used as an adhesive in place of collodion.
- ASET Position Statement: Skin Safety During EEG Procedures – A Guideline to Improving Outcome, Addendum: Neonatal Continuous EEG. approved by the ASET board of Trustees, November 16, 2016
- ASET Position Statement: Skin Safety During EEG Procedures – A Guideline to Improving Outcome, approved by the ASET board of Trustees, November 16, 2016