Nihon Kohden ZB-102AA User Manual

Section 3 EEG/PSG

Measurement

General ................................................................................................................................ 3.1

EEG Waveform Acquisition ....................................................................................... 3.4

About Polysomnography............................................................................................3.4

Flowchart of Waveform Measurement ....................................................................... 3.5

Attaching the Electrodes (EEG Measurement) ....................................................................3.6

Guidelines for Input Jack Use ...................................................................................3.6

Required Electrodes ........................................................................................3.6

Input Jack Z .................................................................................................... 3.6

Input Jacks C3 and C4.................................................................................... 3.6

Input Jacks A1 and A2.................................................................................... 3.6

Checking Original Electrode Potentials for All Active Electrodes ....................3.6

Introduction to Electrode Position, Derivation and Montage ......................................3.7

Electrode Position ...........................................................................................3.7

Derivation ........................................................................................................ 3.7

Monopolar Derivations (Referential Derivation) ................................................3.7

Bipolar Derivation ............................................................................................3.8

Montage (Pattern) ............................................................................................ 3.8

Attaching the Electrodes to the Patient .....................................................................3.9

EEG Scalp Disk Electrodes .......................................................................... 3.10

Electrode Positions ....................................................................................... 3.10

Earlobe Electrodes ........................................................................................3.11

Attaching the Electrodes and Sensors (PSG Measurement) ............................................. 3.12

Measurement Parameters and Attachment Sites .................................................... 3.12

Electroencephalogram (EEG) ........................................................................3.12

Electrooculogram (EOG) ............................................................................... 3.12

Electromyogram (EMG) ................................................................................ 3.12

Electrocardiogram (ECG) .............................................................................. 3.12

Attaching the Electrode ................................................................................. 3.13

Respiration (Airflow, Chest, Abdomen) .......................................................... 3.15

Snore ............................................................................................................3.16

Body Position ................................................................................................ 3.16

Periodic Limb Movements (PLM) .................................................................. 3.16

Oxygen Saturation (SpO2) .............................................................................3.17

Connecting the Electrodes and Sensors to the Electrode Junction Box ............................3.19

Operator's Manual WEE-1000 3C.1

General

3. EEG/PSG MEASUREMENT

Operation

WARNING

When using the NE-224S Sub-dermal Straight Needle Electrode

• Do not use the NE-224S sub-dermal straight needle electrode as a

measurement electrode for the EEG or evoked potential

measurement for any longer than one hour. When measuring the

EEG or evoked potential for over one hour, use the EEG disk

electrode.

• Do not check the skin-electrode impedance when using a needle

electrode or intracranial electrode. Failure to follow this warning

injures the patient because these electrodes will be damaged by

electrolyzation inside the body.

• When measuring the patient with the implantable pacemaker, leave

the instrument (telemetry unit and access point) more than 22 cm

from the patient. Otherwise, the radio wave from the telemetry unit

or access point may interfere with the pacemaker.

• Do not delete any system file in the hard disk of the

electroencephalograph. Otherwise the system may malfunction.

• Periodically back up the EEG data files to prevent loss of data if the

hard disk or MO disk is damaged.

Operator's Manual WEE-1000 3.1

3. EEG/PSG MEASUREMENT

CAUTION

• Do not use a device which uses Bluetooth® wireless technology and

wireless LAN device which complies with IEEE 802.11b near the

wireless input unit at the same time. If they are used together, the

radio waves interfere with each other. This may prevent the

communication between the telemetry unit and access point by

reducing transmission speed and transmission distance.

• Do not give impact to the telemetry unit. Spike noise may be

superimposed on the waveform.

• Use the provided pouch to hold the telemetry unit, electrode junction

box and/or isolator when they are attached to the patient.

• When moving the patient, make sure that the cable connected

between the isolator and access point is disconnected. Otherwise,

the patient may fall over the cable, or the cable may be broken.

• Do not shake or swing the telemetry unit holding the cable

connected to the telemetry unit. The telemetry unit may come off and

it may injure somebody or damage surrounding instruments.

• Do not shake or swing the electrode junction box holding the cable

or EEG lead connected to the electrode junction box. The electrode

junction box may come off and it may injure somebody or damage

surrounding instruments.

• During measurement, do not change the date and time. This makes

the order of the saved event data and the time of the saved

waveforms incorrect.

NOTE

Turn off any screen saver and close all application programs before

opening the Acquisition program. Otherwise, the Acquisition

program may not function properly.

3.2 Operator's Manual WEE-1000

3. EEG/PSG MEASUREMENT

Electrode Attachment/Cable Connection

WARNING

• Do not connect the Z electrode lead plug on the electrode junction

box to a ground or equipotential ground. Otherwise, leakage current

from another instrument cause electrical shock to the patient.

• Only connect a BF type instrument to the DC connector on the

telemetry unit. Otherwise, leakage current from the other instrument

causes electrical shock to the patient.

• Before disconnecting or connecting the cable from/to a connecter on

the telemetry unit, while the telemetry unit is turned on, discharge

electrostatic charge from your body. Otherwise, the telemetry unit

may malfunction due to electrostatic energy.

• When connecting the electrode junction box cable to the electrode

junction box, align the marks on the electrode junction box cable

connector and electrode junction box. Otherwise, leakage current

may cause electrical shock to the patient.

CAUTION

Using a collodion electrode or EEG paste

• If rash, redness or itch appears on the patient skin from the use of collodion or EEG paste, immediately remove the collodion or EEG paste from the skin and perform medical treatment.

• Never allow collodion or acetone to get in the patient’s eyes. If collodion or acetone accidentally gets in the eyes, immediately and thoroughly wash eyes with clean water and perform medical treatment immediately.

• If chemical solution is swallowed, have the person drink water and vomit the chemical solution. Perform medical treatment immediately.

• Collodion is a volatile solvent. Both patients and medical staff must take extreme care not to inhale collodion. When using collodion, make sure there is adequate ventilation. If too much collodion is inhaled, have the person lie quietly and keep warm in fresh air. Perform medical treatment immediately.

Operator's Manual WEE-1000 3.3

3. EEG/PSG MEASUREMENT

EEG Waveform Acquisition

About Polysomnography

The Acquisition program acquires the EEG/PSG waveforms and can display up to

64 channels of EEG/PSG waveforms. You can save the acquired waveforms with

the patient information, annotations, amplifier settings and display settings in a

hard disk or MO disk as an EEG data file. For the operation of the Acquisition

program, refer to the operator’s manual of the electroencephalograph.

The communication between the telemetry unit and the access point can be

checked on the Acquisition screen. You can also change the configuration settings

of the telemetry unit and access point on the Acquisition screen.

Polysomnography is an examination to measure the electrical signals in the body

during sleep. Many different activities are measured during a sleep study. The

basic measurement parameters are electroencephalogram (EEG), eye movement

(EOG), muscle activity (EMG), heartbeat (ECG), oxygen saturation (SpO2) and

respiration. These measurement parameters can help determine what is going on

during sleep. In addition to the basic measurement parameters, we can find the

cause of a sleep disorder by measuring the activity which is suspected to be

causing the sleep disorder

Basic Measurement Parameters

Parameter Electrode/Sensor

EEG Disk electrode

EOG Disk electrode

ECG Disk electrode

EMG Chin Disk electrode

Respiration

Air flow TR-101A /TR-102A Respiration pickup

or Airflow sensor*

Chest/ Abdomen TR-111A/TR-112A Respiration pickup

or Effort sensor*

Periodic limb movements PLM sensor*

Snore Dynamic snoring microphone*

SpO

SpO2 probe**

Sleep position Sleep position indicator*

* Pro-Tech Service Inc.

** Nonin Medical Inc., JL-101A SpO2 sensor adapter is required.

3.4 Operator's Manual WEE-1000

Flowchart of Waveform Measurement

3. EEG/PSG MEASUREMENT

1. Attach the EEG electrodes and sensors to the patient.

2. Connect the electrode junction box and cables to the telemetry unit.

3. Attach the telemetry unit to the patient.

4. Turn on the telemetry unit and access point.

5. Start the Acquisition program (New file automatically opens).

6. Select the telemetry unit and access point.

7. Enter the patient information.

8. Check skin-electrode contact impedance.

9. Lock the telemetry unit.

10. Start EEG/PSG measurement (recording).

11. Display and record the calibration waveforms.

12. Measure the waveforms.

13. End the measurement and close (save) the EEG data file.

14. Close the Acquisition program.

15. Review the saved EEG/PSG waveforms.

After measurement, use the Review program to review and print the waveforms.

Operator's Manual WEE-1000 3.5

3. EEG/PSG MEASUREMENT

Attaching the Electrodes (EEG Measurement)

Guidelines for Input Jack Use

You must follow these guidelines to obtain correct EEG recordings.

Required Electrodes

Do not perform EEG measurement without the Z, C3, C4, A1 and A2 electrodes.

Input Jack Z

Connect the lead from the electrode (Z electrode) attached on the patient’s nasion

to input jack Z on the electrode junction box. This input jack is used to eliminate

AC interference.

The input jack Z is also used for checking electrode impedance.

Input Jacks C3 and C4

The C3 and C4 electrodes are the system reference electrodes for EEG

measurement. Input jacks C3 and C4 must be used for EEG measurement even if

C3 and C4 are not programmed in any montage.

Connect the leads from the electrodes on positions C3 and C4 to input jacks C3 and

C4, respectively.

Input Jacks A1 and A2

The A1 and A2 electrodes are the reference electrodes for skin-electrode impedance

check. Input jacks A1 and A2 in addition to Z, C3 and C4 must be used for the

electrode impedance check.

When checking electrode impedance, connect the leads from the electrodes on

positions A1 and A2 to input jacks A1 and A2, respectively.

Checking Original Electrode Potentials for All Active Electrodes

Check the original electrode potential for all active electrodes by programming a

montage with the system reference (Use the pattern VA (factory default setting) or

select the 0 V button for reference electrode on the Montage dialog box). Refer to

“Programming Patterns” in Section 4 of the electroencephalograph operator’s

manual.

The digital EEG displays the EEG waveform in each channel by subtracting two

electrode potentials selected to a montage. The subtracted result will be incorrect, if

the electrode attachment is not correct, the original electrode potential is flat, or

unstable or artifact is superimposed on the original electrode potential. Omit the

measurement result if the displayed EEG waveform is incorrect.

3.6 Operator's Manual WEE-1000

3. EEG/PSG MEASUREMENT

Introduction to Electrode Position, Derivation and Montage

Electrode Position

There are various systems of electrode position, such as Illinois, Montreal, Aird,

Cohn, etc. Of these, the International 10-20 system, shown below, is currently the

most common. Each system has a different number of electrodes and different

electrode locations. To compensate for different sized heads, the distances between

electrodes are given as ratios.

Nasion

Inion

10-20 system electrode positions

After determining the electrode position system, measure the head of the patient

and calculate the electrode positions according to the distance ratio between each

electrode position. The number of electrodes should be reduced for EEG recording

on infants and little children.

Derivation

Derivation is the electrode combination for one channel. All derivations have two

electrodes: reference and active. In monopolar derivation, one “electrode” can be

several physical electrodes connected together. There are 3 kinds of derivations.

Monopolar Derivations (Referential Derivation)

In the monopolar derivation, one electrode is common to all channels and regarded

as electrically inactive (“reference electrode”). Each amplifier has two inputs (G1

and G2). The reference electrode is connected to the G2 (+) input of the amplifier

and the active electrode is connected to the G1 (−) input.

Monopolar Derivations Using Ear Reference Electrodes:

• Normal Monopolar Derivation

Left ear for left hemispheric derivation and the right ear for right hemispheric

derivation.

• A1 + A2

Shorting both ears (in the electrode junction box).

• A1 → A2 or A1 ← A2

Only one ear.

• A1 ↔ A2

Left ear for right hemispheric and right ear for left hemispheric derivation.

Operator's Manual WEE-1000 3.7

3. EEG/PSG MEASUREMENT

Monopolar Derivations Using Other Site Reference Electrodes:

• Vx (Vertex reference derivation)

Mid-line central position Cz as the reference electrode.

• AV (Average reference derivation)

The potential of all electrodes on the scalp, except for the extra electrodes, are

averaged point and used for the AV reference electrode.

If one or more of the electrodes in the AV electrode contain ECG artifact, or two

or more electrodes show simultaneous abnormal potentials, you need to exclude

any unstable electrodes.

• Aav

The potential of A1 and A2 electrodes are averaged and used for the Aav

reference electrode.

Bipolar Derivation

Electrode pairs are connected to the G1 and G2 inputs of channels. The potential

difference between two electrodes is recorded on each channel.

Montage (Pattern)

Montage is the combination of derivations for all channels. The instrument

contains 36 patterns per set file and you can program a different montage and other

settings for each pattern.

3.8 Operator's Manual WEE-1000

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