Module - EEG in the Intensive Care Setting

Work-based learning outcomes

  1. Plan, prepare and perform EEG recordings in an intensive care setting, siting electrodes using recommended placement system, including any modifications due to the nature of the patient
  2. Report on a range of EEGs recorded from patients in ICU, for example status epilepticus, anoxic/hypoxic brain injury

Work-based Competencies

Learning outcome Title Knowledge
1 1

Control infection risks in accordance with departmental and intensive care protocols

  • Protocols and requirements for hygiene and infection control related to the relevant range of investigations, including preparation, conduct and completion of investigation, and special precautions in the intensive care setting
  • Protocol for hand washing and how effective hand washing contributes to control of infection
2 1

Minimise risks and hazards in compliance with health and safety policies

  • The relevant health and safety regulations specific to neurophysiology investigations, the potential hazards and risks, and the actions to be taken to minimise these
3 1

Plan and prepare for EEG recordings in the intensive care setting

  • Local Standard Operating Procedure for EEG recordings in ICU
  • The range of conditions of patients referred for EEG monitoring in the intensive care setting
  • Special needs of intensive care patients
  • The referral system and the justification for EEG monitoring in the intensive care setting
  • The range and types of information required and its importance
  • Checking for validity of information
  • Appropriate action to be taken in the event of missing or invalid information
  • The purpose of EEG in the intensive care and its appropriateness for the conditions presented
  • Assessment of the appropriateness of the investigation requested with respect to the clinical question and the reason for referral
  • Possible patient needs and environmental needs
  • Factors that may influence the duration and quality of investigations
  • The specific environmental hazards and precautions required in the intensive care setting
  • The effect of medication (sedation) on the EEG
  • Safe and correct operation of the equipment to be used, including all peripheral devices
  • The importance of confirming the patient’s identity from the referral document and correct entry on the recording system
  • The importance of establishing and maintaining effective communication persons associated with the patient (eg nursing staff, relatives, etc)
  • The importance of checking there is adequate storage volume for the investigation to be performed
  • The effects of sensitivity, display speed, filters, CMRR and sampling rate
  • The range of electrodes and transducers used in intensive care recordings
  • Factors of key importance to patient history
  • Information that should be recorded and the checks for validity
  • Appropriate electrode and transducer selection
  • The necessary quantity and type of consumables required
  • Confirmation of the patient’s identity
  • Correct entry/identification on the recording system
  • Recognised measuring systems and how they may need to be adapted in the intensive care setting
  • Contact impedances are confirmed as appropriate to the electrode type and to the patient
4 1

Explain the procedure for the investigation as appropriate to the intensive care setting

  • The appropriate choice of investigation, considering the findings from the history and clinical examination
  • Common questions and concerns of patients relatives/carers about procedures
  • Risks and benefits of undertaking the investigation
  • The information needs of patients relatives/carers following investigation
  • The authority level for provision of information regarding results of investigation
5 1

Gain consent for each type of investigation

  • Local consent procedures when the patient is unconscious
  • Principles, guidance and law with respect to informed consent
6 1

Record an EEG on the unconscious patient in the intensive care setting, identifying and rectifying the non- pathological features and recognising the common EEG features observed in intensive care recordings (eg burst suppression)

  • The importance of a range of control settings and of reviewing throughout the recording
  • The principle and importance of placing electrodes and confirming the contact impedances are appropriate to the patient in the clinical context of the intensive care setting
  • Principles of derivation of montages (referential and bipolar) and electrode placement used for EEG in the intensive care setting
  • The importance of electrode impedance and its effects
  • Correct recording parameters
  • Requirements and principles of recording the EEG in the intensive care setting, including identifying and eliminating biological and non- biological artefacts, in particular the environmental challenges
  • The use and effects of painful, auditory and tactile stimulation
  • The need to modify or extend the current investigation
  • Annotation of ongoing recording
  • Recognition of and correct response to clinical events
  • The effects of sedation on the EEG
7 2

Factually report the recorded EEG, recognising the effects of sedation, and evaluate the findings in the clinical context of the intensive care patient

  • Correct annotation of recordings and other patient documentation and the importance of accuracy, legibility and completeness
  • Normal and abnormal features in EEG, awake and asleep
  • Manipulation of data
  • Drug therapy used in the intensive care patient
  • Identification of the degree of urgency of clinical report

Work-based assessment

Complete 3 Case-Based Discussion(s)
Complete 2 of the following DOPS and/or OCEs
Type Title
DOPS Prepare unconscious patient for EEG recording
DOPS Record EEG in the unconscious patient
DOPS Perform EEG recording during the administration of medication
DOPS Undertake stimulation of the unconscious patient
DOPS Analyse an EEG recording and produce a factual report
DOPS Conduct an infection control and health and safety assessment appropriate to the investigation
OCE Obtain patient history
OCE Measure head in accordance with local protocol
OCE Apply electrodes/transducers in accordance with local protocol
OCE Stimulate patient in accordance with local protocol
OCE Accurately annoated drug administrative and observed changes in patient and their EEG activity
OCE Remove electrodes/transducers in accordance with local protocols
OCE Gain appropriate consent for patient lacking capacity
OCE Conform to appropriate local procedures in place in ITU