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