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Published on: September 6, 2017
Successful Reduction in Electrode-Related Pressure Ulcers During EEG Monitoring in Critically Ill Neonates
Ulrike Mietzsch1, Kristin L Cooper, Mandy L Harris
1Departments of Pediatrics/Division of Neonatology (Dr Mietzsch) and Neurology, Division of Child Neurology (Dr Harris), Indiana School of Medicine, Indianapolis; Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle (Dr Mietzsch); and Department of Neurophysiology, Indiana University Health, Neuroscience Center-Goodman Hall, Indianapolis (Ms Cooper).
Insights
Neonatal intensive care units can reduce pressure ulcers (PUs) during electroencephalographic (EEG) monitoring by implementing electrode-level interventions and regular skin inspections. This approach also prevents infections and minimizes skin irritation in vulnerable neonates.
Area of Science:
- Neonatal intensive care
- Medical device-related complications
- Quality improvement in healthcare
Background:
- Neonates in NICU are highly susceptible to pressure ulcers (PUs) due to immature skin and medical devices.
- Pressure ulcers affect 23% of neonates, with 80% linked to devices like electroencephalographic (EEG) electrodes.
- Prolonged pressure and chemical reactions from conductive agents are proposed causes of PU related to EEG monitoring.
Purpose of the Study:
- To decrease PU in neonates undergoing continuous EEG (cEEG) monitoring by 50% within 12 months and 75% within 18 months.
- To eliminate electrode-related infections within 12 months.
- To monitor gestational age, EEG setup integrity, and cost-effectiveness as balancing measures.
Main Methods:
- A quality improvement project utilized multiple Plan-Do-Study-Act cycles.
- Included all neonates undergoing cEEG monitoring.
- A monitoring tool kit documented scalp and EEG electrode condition before, during, and after cEEG.
Main Results:
- Preproject PU incidence was 8.5%, with 22.2% of those developing infections.
- During the project, PU incidence decreased to 3.5% with no observed infections.
- Over 90% of skin irritations resolved with timely intervention, preventing PU progression.
Conclusions:
- Electrode-level interventions combined with skin inspection effectively reduce PU in neonates.
- Silver/silver chloride-plated electrodes should be avoided in neonatal care due to potential for burns.
- Further research is required to determine the optimal electrode for neonatal EEG monitoring.
Background:
Neonates are at a high risk for pressure ulcers (PU) due to skin immaturity and exposure to various medical devices. The prevalence of PU in the neonatal intensive care unit is estimated to be 23%, with 80% of those being related to medical devices, including electroencephalographic (EEG) electrodes. Proposed mechanisms involve prolonged pressure to the electrodes and chemical reactions to conductive agents.
Purpose:
The object of this quality improvement project was to reduce PU in neonates during continuous EEG (cEEG) monitoring by 50% within 12 months and 75% within 18 months. A secondary objective was to eliminate electrode-related infections by 12 months. Balancing measures included gestational age at the time of monitoring, integrity of the EEG setup, and cost effectiveness. The process measure was adherence to the skin-monitoring tool kit.
Methods:
A multiple Plan-Do-Study-Act cycle method was used. All neonates monitored with cEEG were included. The monitoring tool kit was used to document the condition of scalp and EEG electrodes before, during, and after cEEG.
Results:
In the preproject period, 8.5% (9/106) of monitored patients developed PU, and 22.2% (2/9) of those developed infections. During the project period, 3.5% (7/198) of monitored patients developed PU and no infections were observed. During monitoring, 21 patients showed skin irritation, and timely intervention resulted in resolution in more than 90% of the cases and prevented progression into PU. Silver/silver chloride-plated electrodes, when exposed to external heat sources, can cause burns, resembling PU.
Implications For Practice:
Intervention at the electrode level together with skin inspection successfully reduces PU in neonates. Silver/silver chloride-plated electrodes should be avoided in neonates.
Implications For Research:
Further research is needed to identify the optimal electrode for neonatal EEG.
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