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Electroencephalographic Patterns During Common Nursing Interventions in Neurointensive Care

A Descriptive Pilot Study

Elf, Kristin; Carlsson, Tommy; Rivas, Liliana Santeliz; Widnersson, Emma; Nyholm, Lena

Journal of Neuroscience Nursing: February 2019 - Volume 51 - Issue 1 - p 10–15
doi: 10.1097/JNN.0000000000000411

ABSTRACT Background: Many patients with neurological insults requiring neurointensive care have an increased risk of acute symptomatic seizures. Various nursing interventions performed when caring for these patients may elicit pathological cerebral electrical activity including seizures and stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs). The aim was to explore changes in electroencephalogram (EEG) due to neurointensive care nursing interventions. Methods: A convenience sample was recruited between November 2015 and April 2016, consisting of 12 adult patients with impaired consciousness due to a neurosurgical condition. Continuous EEG and simultaneous video recordings of nursing interventions were collected 48 continuous hours for each patient. Two analysts categorized the video recordings for common nursing interventions, and a neurophysiologist analyzed the EEGs. Results: In total, 976 nursing interventions were observed. Epileptiform activity was observed in 4 patients (33%), during 1 nursing intervention episode each (0.4%). The 4 observed episodes of epileptiform activity occurred during multiple simultaneous nursing interventions (n = 3) and hygienic interventions (n = 1). Stimulus-induced rhythmic, periodic, or ictal discharges were observed in 1 patient (8%), in 1 single nursing intervention (0.1%). The observed SIRPIDs occurred during repositioning of the patient. All patients had muscle artifacts, during 353 nursing interventions (36.3%). The duration of nursing interventions was longer for those with simultaneous muscle artifacts (median, 116 seconds) than those without muscle artifacts, epileptiform activity, or SIRPIDs (median, 89.0 seconds). With regard to epileptiform activity and SIRPIDs, the median durations of the nursing interventions were 1158 and 289 seconds, respectively. Conclusion: The results of this pilot study indicate that muscle artifacts seem prevalent during nursing interventions and may be a sign of stress. Nurses should be aware of the risk of inducing stress by performing regular nursing interventions in daily practice, consider shorter or fewer interventions at a time in sensitive patients, and administer sedation accordingly. Considering that this was a pilot study, more research that investigates correlations between EEG patterns and nursing interventions in larger samples is needed.

Kristin Elf, MD PhD, is Clinical Neurophysiologist and Researcher, Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Uppsala, Sweden.

Tommy Carlsson, PhD PGDip RN RM, is Postdoctoral Researcher, Department for Health Promoting Science, Sophiahemmet University, Stockholm; and Intensive Care Nurse and Researcher, Department of Neuroscience, Neurosurgery, Uppsala University; and Midwife and Researcher, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.

Liliana Santeliz Rivas, MSc RN, is Intensive Care Nurse, Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden.

Emma Widnersson, MSc RN, is Intensive Care Nurse, Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden.

Questions or comments about this article may be directed to Lena Nyholm, PhD RN, at She is Intensive Care Nurse and Researcher, Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden.

This study was supported by Olle Engkvist Byggmästare fund and Swedish Society of Medicine.

The authors declare no conflicts of interest.

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© 2019 American Association of Neuroscience Nurses