Continuous EEG Monitoring and Skin Complications: Review, Analysis and Revision of Practice

Background

Cardiac ICU patients are at high risk for device related skin injuries. The use of electroencephalogram

(EEG) monitoring is essential in the care of cardiac arrest patients undergoing therapeutic hypothermia

(TH). Performance improvement data at our facility indicated skin breakdown was occurring in patients

undergoing EEG monitoring. These injuries are  disconcerting to the individual based on visible

breakdown to the face and head. Skin injuries are often of unknown etiology and may involve either

pressure , chemical and/or abrasive sources. Nurses often misdiagnos these injuries as pressure ulcers

even when no definitive source of pressure may be identified.

Problem

Nursing staff began reporting a higher number of witnessed skin injuries related to EEG monitoring

equipment. Investigation of the process for monitoring revealed variability in technique, patient

positioning and equipment used. Therefore, an interprofessional group of clinicians gathered to identify

skin prevention needs. A retrospective analysis of previous patients who developed skin breakdown was

undertaken, and then compared to a prospective convenience sample of patients receiving an EEG

monitoring intervention bundle of: a fluidized positioner for the occiput, daily changes of EEG probe

location and an EEG probe product change to an alternative chemical conductive gel.

Outcomes

In total, 120 patients were evaluated, with 58 in the retrospective cohort and 62 in the prospective

intervention group. Skin injury occurred in 13/58 patients pre-intervention and in 11/62 in the post

intervention assessment. Anecdotally, the number of injuries appeared to decrease after intervention,

but  numbers remain high.

Discussion

EEG monitoring injuries continue to challenge clinicians as to how to classify, prevent and educate

others about these injuries. Further research is needed to determine the clinical and statistical

significance of the findings in our performance improvement project. More investigation into skin injury

etiology, which guides preventive interventions and EEG monitoring technique is warranted.