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228 Cards in this Set

  • Front
  • Back
When the patient first comes to the lab you should
give a tour
explain the procedure
explain PAP if a titration or split night study is planned
Have them get ready for bed
Remove nail polish
ask about prosthetics
Learn medical history
Review physician's orders
The 10-20 system is a method for _________ EEG electrode placement
Standardizing.
Sites for the elctrodes in 10-20 are determined by
measuring the distance from specific reference points, which are the Nasion, inion, left and right preauricular points
Initial reference points in the 10-20 are used to form....
a virtual grid from which all other measurements are made
It is called the 10-20 systems because...
electrodes are placed at 10 & 20 % of the distance between the reference points
Placement of the exploring electrode is used to ...
target the source and type of brainwave
Sites commonly recorded during a sleep study include
frontal leads (F4,F3)
Central leads (C4,C3)
Occipital leads (O2,O1)
Left side preauricular is labeled
M1
Right side preauricular is labeled
M2
The primary frontal leads used to record and score sleep are the
F4-M1 lead derivation
What is used as backup frontal leads?
F3-M2
Most of the activity related to sleep can be seen in the
central lead derivations, which are C4-M1, & C3-M2
Central leads are referenced to the
mastoid leads
Sleep can be staged from ______, but it is less effective than the full compliment
a single central lead
Posterior view of the head is...
the back of the head
The occipital lead derivations are helpful in identifying___ & ___
alpha wave activity and sleep onset
Alpha wave activity signifies
quiet wakefulness, and can be seen best when the exploring lead is placed over the occiput
The occipital leads are referenced to the
mastoid leads
The transition from wakefulness to sleep is marked by
a change from alpha wave activity to theta wave activity
Occipital leads should not be used to identify
sleep stages
Occipital leads can be helpful when determining __ or __
sleep onset or arousal from sleep
Not all patients will exhibit
alpha activity, which is 8-13 Hz
When marking electrode sites, markings should be _____ to the tape measure
perpendicular
Preauricular points are
depressions located just in front of the tragus at the root of the zygoma. The tragus is the projection of skin covered cartilage in front of the opening of the external ear.
Where do you mark CZ?
50% of measurement from nasion to inion AND L & R preauricular
Where do you mark FPZ?
10% up from the nasion
Where do you mark OZ?
10% up from inion
Where do you mark FZ?
20% up from FPZ or 30% up from the nasion
The preauricular point is easily found by
having the patient open and close the mouth several times
Preauricular landmarks are really just
skull references.
The 10-20 system is measured in
centimeters.
You will need to make a second mark for
CZ.
How do you make the second mark for CZ?
Measure from preauricular to preauricular, making sure to go through the original markings for CZ. Mark at 50%.
How do you verify the site for CZ properly?
Make markings from two planes. 50% from nasion and inion, and 50% from left and right preauriculars.
Lateral Head Measurements would include
C3, C4, T3, T4
How do you find the site for C3 and C4?
From CZ measure 20% down or 30% up from the preauricular mark.
In posterior view, C3 is on the ___ and C4 is on the ___.
C3 is on the left
C4 is on the right
in posterior view
How do you find the site for T3 and T4?
From C3 and C4 measure another 20% down, or 40% down from CZ, or 10% up from preauricular point.
In posterior view, T3 is on the ___ and T4 is on the _____.
T3 is on the left
T4 is on the right
in posterior view
How do you verify OZ?
If was originally marked 10% up from inion. Now measure 50% of circumference of head starting at FPZ.
How do you find the site for O1 and O2?
5% of head circumference. O1 is 5% toward left preauricular and O2 is 5% toward right preauricular.
Make sure that OZ, O2, & O1 are in the same
horizontal plane.
How do you find FP2 and FP1?
5% left and right of FPZ. FP2 is on the right, and FP1 is on the left.
In the 10-20 System, ____ numbers are on the right and _____ numbers are on the left.
Even numbers are on the right and odd numbers are on the left.
How do you find FP2 and FP1?
Measure from FPz 5% to each side
Where do you place the reference electrodes?
At the top of the mastoid process, behind the ear, on the bony area.
What do you avoid when placing the reference electrodes?
Avoid the tip which is often covered with fatty tissue.
Where is the tip of the mastoid process?
At the bottom of the mastoid process?
In prepping the electrode site, remove the top layer of dry dead skin cells to _____
reduce the natural impedance of the skin and hydrate the remaining cells.
How do you prep a site for electrodes?
Use a cotton swab or applicator with abrasive skin-prep and lightly abrade.
What is the first layer of the epidermis called?
stratum corneum
What is one of the major determinants of the impedance of the electrode?
proper preparation of the skin
Impedance defined
Impedance is a measure of resistance to the flow of electrical current
The lower the impedance, the _______ the signal
better
High impedance ________ signal amplitude
decreases
What is the maximum recommended electrode impedance?
5k ohms (5000 ohms) or (5 kilohms) or (5Ω)
Factors that influence impedance:
Thickness of skull, thickness of stratum corneum, and length, gauge, and continuity of electrode wire
Ways to reduce impedance
abrade skin to reduce thickness, and keep electrode wire length as short as possible and in good condition
An impedance meter is used to measure the impedance from the source to the ______
amplifier
How do you prep the electrodes?
Make sure they're clean and working, fill the electrode cup with conductive paste or gel
EOG=
Electrooculography
Electrooculography records ___
the difference in electrical potential between the front (cornea) and back (retina) of the eye.
The recording of eye movements is necessary for ____
sleep staging.
front of the eye is called____ , and is + or -?
cornea and is positive +
back of the eye is called ______, and is + or -?
retina and is negative -
What is placed 1 cm above the right outer canthus (ROC) of the eye?
E2
The electrode E1-M2 should be placed 1 cm below the _______
left outer canthus (LOC) of the eye
E2 and E1 when eyes are looking right?
E2 + (wave pointing down)
E1 - (wave pointing up)
E2 and E1 when eye are looking ahead?
both straight horizontal lines
E2 and E1 when eyes are looking up?
E2 + (wave pointing down)
E1 - (wave pointing up)
E2 and E1 when eyes are looking left?
E2 - (wave pointing up)
E1 + (wave pointing down)
E2 and E1 when eyes are looking down?
E2 - (wave pointing up)
E1 + (wave pointing down)
What do electromyography leads record?
Muscle activity
Movement causes increased firing of _______, which is detected as increased _______.
motor neurons / muscle activity
Typical EMG leads used during polysomnography include
chin and leg
How many electrodes should be placed to record chin EMG?
3
Where are the electrodes to be placed for a Chin EMG?
-1 cm below inferior edge of mandible
-2 cm below inferior edge of mandible and 2 cm right
-2 cm below inferior edge of mandible and 2 cm left
Where do Leg EMG electrodes go?
on the belly of the anterior tibialis muscle
Leg EMG electrodes should be spaced ______, located ____
2-4 cm apart, away from any bone and in a straight line
Prep sites should be small and separate to avoid forming a
salt bridge, the flow of electrical current between the two electrodes.
When does a salt bridge occur?
When two electrodes occupy the same prep site.
Electrocardiography leads measure
the electrical activity of the heart
Multiple electrocardiography leads can give a
3 dimensional view of cardiac activity
The leads most commonly monitored during PSG ECG require electrodes in the
right and left subclavicular region and left mid-thorax.
The subclavicular electrodes are placed
just below the mid point of the clavicle
The mid-thorax electrode is placed in the
8th intercostals space below the midpoint of the clavicle.
What is recommended for ECG
a single modified EDG Lead II using torso electrode placement
ECG electrodes are placed
just below midpoint of right clavicle and another in the 8th left intercostal space below the midpoint of the left clavicle
What are the two types of snoring sensors?
acoustic (microphone) and Piezo
Microphone (acoustic) sensors create a signal based on
detected sound
Piezo snore sensors create a signal based on the
vibrations that occur during snoring
The sensor to detect absence of airflow for identification of an apnea is
an oronasal thermal sensor
The sensor for detection of airflow for identification of a hypopnea is
a nasal air pressure transducer with or without square root transformation of the signal
The sensor for detection of respiratory effort is
either esophageal manometry, or calibrated or uncalibrated inductance plethysmography
The sensor for detection of blood oxygen is
pulse oximetry with a maximum acceptable signal averaging time of 3 seconds.
These sensors are used to monitor nasal and/or oral airflow...
flow sensors
________ is the gold standard for assessment of airflow
The pneumotachometer
What gives an accurate measure of tidal volume?
The pneumotachometer
The use of a pneumotachometers is limited by
the requirement for a tight fitting face mask
Fluctuations in nasal pressure is detected during
inspiration and expiration
The changes in nasal air pressure are______________ to changes in flow.
predictably related
The nasal pressure change is detected by a __________
nasal cannula
Once pressure change is detected by a nasal cannula, it is changed to
a flow signal by a transducer.
Nasal pressure is a(n) ________ measure of airflow
fairly accurate
The signal is related to nasal pressure is _______ to flow.
proportional
The ____ and _____ of the flow wave are similar to the pneumotachometer in most situations
amplitude and morphology
The amplitude and morphology of the __ are similar to the pneumotachometer in most situations
flow wave
The amplitude and morphology of the flow wave are similar to the
pneumotachometer in most situations
The best signal for nasal pressure is achieved using a(n)
DC amplifier
Apneas and hypopneas cannot be differentiated by
nasal pressure measurements
A flat line signal in nasal pressure may represent
apnea or moth breathing
Thermistor/Thermocouple sensors _________ measure airflow.
do not directly
Thermistor/Thermocouple sensors detect
the change in air temperature between inspiration and expiration
How do Thermistor/ Thermocouples work?
Air is warmed in the body, therefore temp. of exhaled air is higher than inspired air. The degree of temp. change is used to infer change in flow.
Unlike nasal pressure, the change in temp. using Thermistor or Thermocouple is
not proportional to airflow
Unlike nasal pressure, using Thermistor or Thermocouple is a ______ rather than ______ signal
qualitative rather than quantitative
Thermistors are made from materials whose resistance to an electrical current varies with
changes in temperature.
The degree of change in resistance (in Thermistors) is used to
reflect change in airflow.
Thermistors. The change in airflow is ___________to the change in resistance
is not directly proportional
Thermistor is a sensor that requires the use of a
power source.
Be careful to keep the thermistor from touching the skin or it will
remain at body temp. and not vAry with air temp.
What principle are Thermocouple sensors based on?
That when two different metals are brought together they produce a measurable electrical current.
Thermocouples. A change in temp changes the
electrical current between the metals.
Thermocouples. The degree of change in _____ is used to reflect change in airflow.
voltage
Thermocouple. The change in airflow is ______ to the change in voltage.
is not directly proportional
Thermocouple sensors _____ a power source.
doesn't require
There are multiple methods for measuring respiratory effort, both _____ and _____.
quantitative and qualitative measures.
Respiratory effort measures are necessary for differentiating between
obstructive and central apneas.
During normal breathing, Contraction of the ____ causes rib cage expansion and downward movement of the diaphragm.
diaphragm
What pushes out the abdominal walls?
contraction of the diaphragm, which causes rib cage expansion and downward movement of the diaphragm
During normal breathing, enlargement of the thoracic and abdominal cavities occur at the same time, or _____,
in phase.
______ movement of the thoracic and abdominal cavities occurs with respiratory muscle disorders or with complete and partial occlusion of the upper airway.
Paradoxical, or out of phase
Effort sensors measure
expansion and contraction of the thoracic and abdominal cavities, reflecting effort to breathe
Some respiratory effort sensors measure only
effort
What respiratory effort sensors only measure effort?
Intercostal EMG, and esophageal pressure manometers.
Some respiratory effort sensors measure effort and ___
lung volume
What respiratory effort sensors measure both effort and lung volume?
Strain gauges, impedance plethysmography, inductance plethysmography
Inductance is a measure of
the opposition of a conductor to a change in electrical current flow
In inductance, a conducting wire is sewn into effort belts placed around _____and a small electric current is passed through the wire.
the chest and abdomen
In inductance, changes in ______ change in inductance of the sensor
shape and diameter of the conducting wire
In inductance, breathing alters the cross-sectional area of the chest and abdominal cavities, changing
the diameter of the wire and the inductance of the sensor.
The change in inductance is related to
volume change and effort
In inductance, uncalibrated measurements give
qualitative signals
In inductance, when fully calibrated, the _____ gives an accurate measure of tidal volume
the sum of the two signals
The inductance sensor also allows measurement of the phase relationship between the two
effort belts
Inductance can be helpful in detecting airflow limitation and
respirator effort related arousals (RERA)
What are the limitations of Inductance Plethysmography?
The belts are prone to slippage with patient movement, changing the accuracy of the measurement; and calibration is difficult, particularly in the morbidly obese patient
Impedance is a measure of
the ability of a substance to conduct an electric current
Impedance is determined by
the size and composition of the conducting substance
In the case of impedance plethysmography, the conducting substance is the
chest cavity
Impedance plethysmography, a small electric current is passed through
the chest between two electrodes
In impedance plethysmography, breathing changes the cross-sectional area and the amount of air and blood in the
thoracic cavity, altering the impedance
In impedance plethy., the change in current flow can be
measured and displayed
Impedance measurements are not proportional to ______ (in impedance plethysmography)
changes in lung volume
Impedance measurements are are ___ signal
qualitative
Impedance plethysmography often used in children
pneumogram, place electrodes in line with nipples subaxillary
A limitation of impedance plethy is signal degradation can occur with
body position changes
A limitation of impedance plethy is its prone to
muscle and cariogenic artifact
Impedance plethy sensor is unable to
assess thoracoabdominal coordination
Impeduance plethy sensor is unable to distinguish between _______
central and obstructive events
Intercostal EMG recordings measure
activity of the muscles involved in breathing
Intercostal EMG electrodes are placed on the skin in the intercostal space between the
lower ribs
Intercostal EMG electrodes are placed at the site of insertion of the
diaphragm into the rib cage
Intercostal EMG is an _____signal but can detect increases in ___
uncalibrated; muscle activity
A limitation of intercostal EMG is the signal is inhibited during
REM due to muscle atonia
A limitation of Intercostal EMG is that non-respiratory muscle EMG ____ may be difficult to eliminate
artifact
In intercostal EMG recordings is it difficult to find the proper electrode location?
yes, especially in obese patients
Esophageal pressure manometry is the reference standard for the measurement of
respiratory effort
An esophageal catheter is passed through to ____ into the ____ to measure _______
nose; esophagus; pressure changes
Esophageal pressure is a reflection of _____, the pressure in the cavity surrounding the _____
intrapleural pressure; lungs
Diaphragm contraction and rib cage expansion during inspiration causes the pleural pressure to ______, inflating the _____
decrease (become more negative), inflating the lungs
Changes in pleural pressure cause similar changes in
esophageal pressure
How are esophageal pressure changes detected?
by air-filled balloons or fluid-filled catheters that are attached to transducers and signal amplifiers, creating the esophageal signal tracing
As respiratory effort increases, the esophageal pressure becomes
more negative
Esophageal pressure is a reliable, accurate, _______ measure of ______.
Quantitative measure of respiratory effort
Esophageal pressure manometry is the most accurate measure and the reference standard for the detection of
RERAs and central events
Limitations of Esophageal Pressure Manometry may include:
trauma to nose, pharynx or esophagus; must take care to avoid tracheal intubation; discomfort can disturb sleep; movement can alter position of tube and change the accuracy of the measurement; and improper location or catheter filling can give inaccurate readings
Esophageal Pressure manometry is not utilized in most clinical laboratories due to
patient comfort issues
The Pulse Oximeter derivation is matched to what sensor site?
finger
Pulse Oximetry measures
oxygen levels in the blood
Pulse Oximetry detect the amount of oxygen bound to the
hemoglobin molecules of the red blood cells
Average value of oximetry___
Acceptable level: _____
Avg 95%
Acceptable ≥ 90%
The Oximetry probe is placed on an area with thin skin and blood vessels close to the surface (ex: ____)
finger or ear
In Oximetry, two wavelengths of ____ are passed through the skin and detected by a sensor placed on the other side
light (red and infrared)
The wavelengths of light that pass through to the oximetry sensor are determined by the
amount of oxygen bound to the hemoglobin molecules
Pulse oximetry is relatively simple and is the most reliable method for
noninvasively assessing oxygen levels
Limitations of pulse oximetry include:
Signal averaging time should be 3 seconds; doesn't reflect total gas exchange (doesn't measure CO2); poor readings from inadequate blood flow (ie.e peripheral vascular disease, heart failure); and nail polish can cause inaccurate measurements
A capnograph measures
carbon dioxide CO2.
What are the two types of capnographs?
End-tidal and transcutaneous
End-tidal CO2 measurements are made by detecting CO2 from
the nose and/or mouth
Transcutaneous CO2 measurements are made by detecting CO2 in
the blood vessels of the skin
Expired air has a higher concentration of CO2 than
the ambient air
Accurate end-tidal capnograph measurements require
a tight fitting mask
End-tidal capnograph measures CO2 throughout
the breathing cycle
End-tidal measurements, taken at the end of expiration, reflect the concentration of
CO2 in the lungs and in the blood
The normal range for end-tidal measurements is
35-45 mmHg
Blood CO2 is a measure of
effective ventilation (Hypoventilation increased CO2 levels)
It is difficult to make accurate end-tidal measurements so it is best to follow
trends
Transcutaneous CO2 measurements cons:
probe heats the skin and must be moved frequently; accuracy of this method is limited by the varying skin thickness of adults
Score hypoventilation during sleep as present if there is a
>10 mmHg increase in PaCO2 during sleep in comparison to an awake supine value
Steps to perform after placing electrodes:
1 patient in bed
2 perform a check on your setup
3 perform an impedance check
4 all channel calibrations
5 montage testing (Bio-calibrations)
In an impedance check, be sure all impedance values are within
your lab's limits
During an all channel calibration, make sure that
like channels appear the same (method of detecting a bad amplifier)
____ and ___ are necessary to protect both the patient and tech from dangerous and preventable infections
Decontamination and infection precautions
The goal is to prevent transmission of ____ between patients and techs.
pathogens
All equipment should be ____ and ____ before being put on a patient
cleaned and sterilized
All patient contacts and waste should be approached as if
the patient has an infectious disease, regardless of their status, this is the principle of universal precautions
The tech should take preventive steps before any patient contact, especially
hand washing
What are some barrier precautions?
gloves, masks, goggles/glasses, gowns, jackets
Immunization of techs:
Prevents development of infections; hepatitis B, influenza, pneumonia, measles, mumps, rubella
Decontamination of equipment is a form of
infection control
Methods of decontamination:
Cleaning-removal of gross material
Disinfection-elimination of organisms other than bacterial endospores (non-sporicidal)
Sterilization-elemination of all microbial life
Agents Used for disinfection and sterilizations:
Germicides and disinfectants
Germicides are
agents that kill micro-organisms on living tissue and surfaces (Virucides, bactericides, fungicides, sporicides)
Disinfectants:
used only on inanimate objects; contain strong toxins that could harm people
Control of pathogenic microorganisms is accomplished by varying levels of decontamination:
Critical, Semi-critical, and non-critical
Explain the "critical" category of decontamination
Must be sterilized; for objects introduced into sterile environments, ie tissue, esophageal catheters, needles
Explain the "semi-critical" category of decontamination
Must undergo high-level disinfections; for objects in contact with intact mucous membranes or body fluids, ie Thermistors, CPAP tubing, & Masks
Explain the "non-critical" category of decontamination
Must be cleaned; for objects that come in contact with intact skin, ie stethoscopes, blood pressure cuffs, oximeter probes
The proper approach to patient contact include:
washing hands
wearing gloves
avoid injuring the patient
clean the equipment
What is he most effective means of controlling infection?
hand washing
When to wear gloves:
for all patient and equipment contacts
Change gloves when
moving from dirty to clean equipment and patient to patient
After removing gloves, you should
wash your hands
Why and how to avoid injuring the patient:
Avoid causing a breaking the skin, which increases risk of infections. Remove electrodes and sensors carefully. Don't over abrade
When cleaning the equipment, remove ___ and ___ from electrodes and sensors
tape and adherents
When cleaning the equipment, remove dirt and organic material with
soap, detergents, or enzymatic products
What should be disinfected with a high level disinfectant?
Electrodes, sensors, masks, and tubing