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Essential IONM O.R. Awareness For IONM Interns and Observing Students By Diana Chen Copyright © 2007 by Diana Chen. All rights reserved.

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Presentation on theme: "Essential IONM O.R. Awareness For IONM Interns and Observing Students By Diana Chen Copyright © 2007 by Diana Chen. All rights reserved."— Presentation transcript:

1 Essential IONM O.R. Awareness For IONM Interns and Observing Students By Diana Chen Copyright © 2007 by Diana Chen. All rights reserved.

2 Ideal Candidates Observing students:  Should have successfully completed IONM Part 1 past Mid-term exams. Intern  Should have successfully completed Functional Human NeuroAnatomy, IONM Part I and/or Part II.

3 Attire Change in locker room:  Scrubs (shirt-pant set) will be provided  Shoe covers, place over sneakers  Hair cap, conceal all hair strands  Wash your hands well  Bring a combination lock, if desire Before O.R. entry must wear mask with shield (unless eye glasses are worn)  Interns: also wear gloves in O.R. Must wear lead apron if C-arm present, or stand behind someone who is.

4 Introduction Observing Students and Interns:  Must call Head Surgical Nurse 30-60 min. prior to surgery Patient must approve of your presence  After getting dressed check-in at the Nurses Station Write your name and Surgeon you will observe  Upon entering O.R. must introduce yourself to Circulating Nurse as “student with NeuroTrend” Staff awareness  Finally Introduce yourself to NeuroTrend Technologist

5 Environment Zone Observing students: Semi-restricted zone  Must wear full scrub attire and mask  Permitted 5 feet away from Patient and 3 feet away from Sterile tables. Interns: Restricted zone  Full scrub attire, mask and gloves  Work permitted near (>12 inches) sterile setup  If Sterile Surgical group begins to approach Patient zone, Intern must allow Tech to resume, if further work is to be done.

6 Sterile Equipment Tables with blue sheets  Trays on top contain sterile items Any Instrument with transparent plastic covering, for example:  C-arm  Microscope Anesthesiologists Table Patients bed/linens

7 Access Revoked Observing students and Interns know that you could be asked to leave by:  Head Nurse  Circulating Nurse  Surgical Team Causes:  Entering without proper attire, must have mask on  Disturbing interruptions  Crossing any prohibited zones  Doing anything you are not there to do, unless asked by any of the above persons or the Technologist.

8 Persons in O.R. during Surgery Surgical Team  Surgeon  Physician’s Assistant  Scrub Nurse  Anesthesilogist IONM Technologist (and you) Circulating Nurse Radiologist Brain Imaging Specialist, if needed Hardware Representative

9 Basic IONM tools Surface and/or Needle electrodes 3M Tape Pods for leads (# depends on case need) Stimulators (depends on case need) Pre-amp box Junction box Internet connection/PC Printer, if not electrically stored Folding table

10 Basic Surgical tools Cutting  Scalpels  Scissors  Bone cutters  Powered drills Grasping  Tissue forceps Clamping  Hemostats; control bleeding  Crushing Skull clamp  Non-crushing Vascular Clamps Artery clamp Irrigating (always cold) Exposing and Retracting  Electrocautery (hand held or foot pedal) Low Voltage heat produces very fast, result vaporized tissue. Hi Voltage pulse AC current, heat produces slower, causes blood coagulation Monopolar Bipolar Suturing  Internal staplers  Skin staplers Viewing  Microscope with Monitor

11 Common IONM Modalities SSEP MEP BAER EMG (free run and triggered) EEG TceMEP

12 Spinal Cord Nerves and their Innervated Muscles C3-C4; Trapezius (neck muscles) C4-C5; Rhomboids (diaphragm) C5-C6; Biceps and Deltoid C7-C8; Triceps and long muscles of forearm C8-T1; Abductor Pollicis Brevis, First Dorsal Interosseous (fine hand movements) L1-L2; Iliopsoas (flexors of thigh) L3-L4; Vastus Lateralis L4-L5; Anterior Tibialis L5-S1; Gluteus Maximus, Hamstring S1-S2; Gastrocnemius (plantar flexors of ankle) S2-S4; Anal Sphincter

13 Supplementary info Nerves vs. Vertebrae  Cranial 8:7  Thoracic 12:12  Lumbar 5:5  Sacral 5:5  Coccyx 1:4 Sensory & Motor innervation of reflexes  Bicep reflex; C5, C6  Brachioradialis reflex; C6  Tricep reflex; C7  Finger reflexes; C8  Knee reflex; L3, L4  Adductor reflex; L2  Cremasteric reflex; L1,L2  Plantar reflex; L5  Ankle reflex; S1  Anal reflex; S4, S5

14 SSEP Nearfield/Farfield (NF/FF) Median/Ulnar  EP: NF, peripheral nerve  N13: NF, stationary record ref., cervical  P14: FF, subcortical  N18: FF, subcortical  N20: NF, cortical Tibial/Peroneal  PF: NF, peripheral nerve  N34: FF, subcortical record ref. from Fpz  P37: FF, cortical

15 IONM Basics Stimulating electrodes placed close to nerves:  (-) Cathode: black; active Depolarizes in one direction, away from anode  (+) Anode: red Placed 3 cm distal to cathode Ground: green Recording electrodes  From nerves  From brain waves

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17 For Your Use

18 Student Obligation Part I Visit www.ASET.org Each student participating must read and understand the following competencies:www.ASET.org  National Competencies for Performing Intraoperative Physiological Monitoring  ASET Position Statement on Electroneurodiagnostic Technologists in the Operating Room  The Role of Electrodiagnostic Technologists in the Operating Room

19 Student Obligation Part II HIPPA (Health Insurance Portability and Accountability Act) Regulations Each student participating must understand this regulation is the Law. Highly summarized:  Patient information is not to be discussed in the presence of anyone that is not in the O.R. and even then Patient name should not be used in the conversation ever!  Patient record should never leave the users location.  Do not ever write down or exchange any Patient Identification data.  Pre and Post surgery do not discuss a surgery case in ear shot of family members or public persons period. Violators of the Law go to JAIL! For more detailed information visit:  http://www.hipaaps.com/what.html http://www.hipaaps.com/what.html  http://www.hhs.gov/ocr/hipaa/finalreg.html http://www.hhs.gov/ocr/hipaa/finalreg.html

20 Signature of Compliance Before entering any Hospital we will need you to sign a Student Obligation’s Checklist indicating you agree and understand all items on the checklist. Turn the form in, in exchange for scrubs. If your going to be absent for your appointed date, please email in advance or call Diana Chen. Thank you for your interest


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