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Published on: June 25, 2016
EEG-related deep tissue injuries in critically ill pediatric patients: A single institution quality improvement
Joel Willard1, Megan Creed1, Lincy Philip1
1Division of Child Neurology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York, USA.
Insights
Prolonged EEG monitoring in critically ill infants can cause scalp injuries. A quality improvement project successfully reduced these injuries from 0.30% to 0% by implementing expert guidelines and tailored skin care protocols.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Biomedical Engineering
Background:
- Neurologic complications, including seizures, are frequent in pediatric cardiac surgery patients, particularly those on extracorporeal membrane oxygenation (ECMO).
- Prolonged electroencephalogram (EEG) monitoring is crucial for these patients but carries a risk of scalp and pressure injuries.
- Skin integrity is vital, as microcirculatory changes can indicate overall tissue perfusion in critically ill infants.
Purpose of the Study:
- To assess and reduce scalp injuries associated with prolonged EEG monitoring in critically ill neonates and infants.
- To implement a quality improvement (QI) project incorporating best practices for electrode placement and skin safety.
- To evaluate the effectiveness of the QI protocol in preventing deep tissue injuries (DTIs).
Main Methods:
- A QI project was initiated, reviewing baseline data from 2336 inpatient video EEGs (January 2022-December 2024).
- Interventions focused on improving skin safety during electrode placement, guided by American Clinical Neurophysiology Society (ACNS) and ASET guidelines.
- Monitoring parameters and skin preparation techniques were refined.
Main Results:
- Five critically ill infants developed deep tissue injuries (DTIs) related to EEG electrodes, primarily in the occipital region.
- The frequency of scalp injuries decreased significantly from 0.30% in 2022 to 0% in 2024 following protocol implementation.
- Injuries were more prevalent in patients with known hypoperfusion.
Conclusions:
- Electrode-related skin injuries are a notable complication of prolonged EEG monitoring in critically ill pediatric patients.
- Adherence to expert guidelines and tailored skin care protocols can effectively minimize the risk of these injuries.
- Further research is necessary to optimize safety protocols for this vulnerable population.
Introduction:
Neurologic complications, including seizures, are common in pediatric patients undergoing heart surgery, especially those requiring postoperative extracorporeal membrane oxygenation (ECMO), requiring prompt, vigilant postoperative monitoring. Prolonged EEG monitoring in critically ill children presents a risk of scalp/pressure injuries. The skin's sensitivity to microcirculatory changes can also provide valuable insights into the patient's overall tissue perfusion, making it a critical component in the management of these vulnerable patients.
Methods:
We initiated a quality improvement (QI) project to assess and reduce scalp injuries related to prolonged EEG monitoring in critically ill neonates and infants. The project involved reviewing baseline data, which included 2336 inpatient video EEGs performed from January 2022 to December 2024, and implementing interventions to improve skin safety during electrode placement, while incorporating best practices from ACNS and ASET guidelines.
Results:
Five critically ill infants developed deep tissue injuries (DTIs) related to EEG electrodes, with most injuries occurring over the occipital region. The frequency of scalp injuries decreased from 0.30% in 2022 to 0% in 2024 after implementing the QI protocol, and was observed in conditions with known hypoperfusion.
Discussion:
Electrode-related skin injuries are a common complication of prolonged EEG monitoring, particularly in critically ill pediatric patients. Our findings suggest that adherence to expert guidelines and tailored skin care protocols focused on skin preparation, electrode application, and monitoring parameters can reduce the risk of electrode-related skin injuries. Further research is needed to refine safety protocols and address the unique skin care challenges faced by this high-risk population.
