BRM Monitor

 

 Reviewed by Robin Gardner
and Malcolm Battin
Jan 2009
Clinical Guidelines Back Newborn Services Home Page

Indications

Application

Commence Assessment

Check Contact Quality

Mark Events

Suspend Monitoring

Turn Off

The following policy/recommended best practice outlines practice applies to all Medical and Nursing staff working in Newborn Services.

Indications

The following infants should be considered for Brainz BRM monitoring.

Infants ≥34/40 with:

Monitoring should not be commenced unless directed by a doctor/NS-ANP.

Application

Electrodes to be applied by newborn Medical and Nursing staff who have undertaken BrainZ BRM training.

Equipment required:

There are two electrode options available, hydrogel and sub-dermal needle electrodes. Note sub-dermal needle electrode must only be used in consultation with a doctor/NS-ANP.

Hydrogel Electrode Placement

Step
Action
1
 Position infant supine
2
 Using sensor positioning strip, measure from the sagittal suture to the tragus of the ear. Align so each end point has the same letter (A,B etc) TapePlacement.jpg (43950 bytes)
3
 Mark the site for electrode placement.

Note: DO NOT shave these placement marks

 Marking.jpg (25681 bytes)
4
 Clean the marked areas with water and gauze, parting the hair in a line towards the top of the head
5
 Gently pat dry with gauze maintaining the part in the hair
6
 Using cotton tips clean the area with a very small amount of NuPrep® SkinPrep.jpg (17105 bytes)
7
 Using gauze and water clean off the NuPrep®, continuing to maintain the parting.
8
 Pat dry the area.
9
 Site electrodes in the following manner.
  • All leads to be directed to the top of the head
  • Black electrode placed at the back
  • Purple electrode placed in front
  • Note: The left & right labels on the sensor cable correspond with the babies left & right
  • Ensure electrodes do not touch
  • Once applied, pat around edge of electrodes with a cotton wool swab
 PlaceSensors1.jpg (28447 bytes)PlaceSensors2.jpg (24427 bytes)
10
 Gently turn infants head over and repeat process. TurnHead.jpg (33087 bytes)
11
 Apply head wrap with adequate tension to support electrodes.
12
 Site the green reference electrode,
  • select a site with no hair on or near the shoulder
  • Note the same cleaning process is required
 ReferenceSensor.jpg (39933 bytes)
13
 Plug into the data acquisition unit (DAU) Connect.jpg (43420 bytes)
14
 Note: If electrodes lift, remove carefully placing electrode onto plastic. Repeat cleaning process and replace. Do Not stop the machine. Continue monitoring, mark event.

Sub-dermal Needle Electrode Placement

Step
Action
1
 Position infant supine
2
 Using sensor positioning strip, measure from the sagittal suture to the tragus of the ear. Align so each end point has the same letter (A,B etc). TapePlacement.jpg (43950 bytes)
3
 Mark the site for electrode insertion.

Note: DO NOT shave these insertion marks.

 Marking.jpg (25681 bytes)
4
 Clean the scalp around the insertion sites with cleaning solution appropriate for gestation age. It may help to create a vertical part in the hair.
5
 Site electrodes in the following manner.
  • Insert a needle electrode subdermally at insertion sites.
  • Black needle electrode placed at the back
  • Purple electrode at front
  • Ensure all leads are directed to the top of the head
  • Secure electrode with a small amount of tape using a cross over method
  • Connect electrodes to the sensor adaptor set

6

 Gently turn infants head over and repeat process.
7
 Apply head wrap with adequate tension to support electrodes.
8
 Site the green reference electrode,
  • select a site with no hair on or near the shoulder
  • Clean the area with water and gauze
  • Using cotton tips clean the area with a very small amount of NuPrep®
  • Using water and gauze clean of the NuPrep®
  • Site electrode with lead directing towards the head
  
9
 Plug into the data acquisition unit (DAU)

Commence Assessment

Step
Action
1
Plug monitor into wall power supply.
2
Turn on the AC power switch (at back of monitor).
3
On main menu screen touch the ‘assess patient’ button to display the new patient screen.
4
Touch the white field next to display the on-screen keypad.
5
Typing the appropriate data, touch enter at the end of each entry.

6

 Touch the appropriate check box to select the gender.

7

 Use arrows to adjust birth weight / current weight.

8

 Touch appropriate date on calendar to enter birth date.

9

 Patient name, NHI, and clinicians initials must be entered before assessment can commence.
10
Once assessment has commenced you can return to this page to complete if required
  • press tools
  • patient details
  • enter any additional patient details (as above)

Check Contact Quality

Contact impedance is displayed on the ‘signal status screen’.

Step
Action
1
 On main menu screen touch the ‘check signal’ button.
2
 All 4 dots displayed on the graphics should be green.
3
 If dots are yellow or red check the corresponding electrode.
4
 Once all dots are green press the ‘OK’ button.

Mark Events

During monitoring Mark events i.e. suctioning, cares, observation of seizure-like movements, administration of anticonvulsants

Step
Action
1
 Touch ‘mark events’ button.
2
 Touch white description area to display the onscreen keypad.
3
 Enter a brief note.
4
 Touch enter, then OK.
5
 A green line and number will appear on the aEEG graphics. To recall the event data touch the green line on the screen.

Suspend Monitoring

Step
Action
1
 Press stop.
2
 On confirmation screen, press suspend
3
 Disconnect electrodes / cable from DAU (as required)
4
 When ready to recommence, plug cable back into DAU and press resume assessment

Turn Monitor Off

Step
Action
1
 On main menu screen touch ‘shutdown’ button.
2
 On confirmation screen touch yes.
3
 Once screen says shutdown complete, turn AC power off.
4
 Remove sensors by dampening the gel with water.

References

1
 BrainZ BRM2 Brain monitor reference manual