By Sandy Penney R. EEG T./RPSG., Madison Gonet R. EEG T., Chris Simpson R. EEG T.
The EEG head wrap is a crucial step in the electroencephalogram process. Traditionally a head wrap is called for when the patient will have a long-term study, ambulatory EEG study, or any time the technologist would like to ensure the leads are secured to the patient’s head. There are many times, especially when EEG is depicted on TV, when a head wrap isn’t used.
Head wraps can not only keep electrodes in place, but they can also create a barrier. This barrier prevents the patient from disturbing them and creating artifacts on the collected data. When well-executed, a head wrap is a nice finishing touch on the patient that safeguards electrodes on the scalp. If working with children, the head wrap can be a nice way of hiding intimidating-looking wires.
Much like tying a necktie, there are different ways to accomplish this. Today we’re demonstrating a tried-and-true method to perform an elegant and functional EEG head wrap. Here’s a step-by-step guide.
Prepare for the EEG Head Wrap
By this point, let’s assume the patient already has their electrodes in place. The patient is ideally seated comfortably while you are standing with your materials nearby and ready. Have your head wrap gauze and tape within reach. We recommend pre-cutting 6-8 medium-length strips of tape for efficiency. In this demonstration, we’re using stretch-gauze, but there are different kinds of gauze for different situations.
Starting the EEG Head Wrap (Steps 1 – 5)
1. We recommend starting above the patient’s left ear and working from front to back. Make sure you cover the electrodes on the forehead. As you work your way around the head, try to go as far down low and behind the ears as you can. This can help the wrap overall become tauter. By this time the wrap should meet above the left ear again making your first complete pass.
2. Make another pass around the patient’s head – almost the same as last time and making sure to get low on the back of the neck.
3. When you reach above the left ear, this time start to pass over the front-top of the head completely covering the F8, F4, FZ, F43, and F7 leads. This may also include most of the leads on the very top of the head. This depends on the size of your gauze and the patient’s head. End at the right ear.
4. Start to move down the side of the patient’s head now from BEHIND the right ear and start making a chin-strap, gently twisting the gauze a couple of times to provide some looseness for patient comfort. Wrap under the chin near the neck using a few extended fingers to provide at least 2 inches of slack so the chin strap isn’t too tight. As you bring the gauze up the patient’s left side, keep the roll in front of their left ear and don’t go behind it as you did on the right side.
5. Repeat step 4 to make a second chin strap. This time remain in front of the patient’s right ear, go under the chin, and come up on the left side behind the left ear. Now you should have formed what appears to look like bike helmet straps for your patient.
Finishing the EEG Head Wrap (Steps 6-10)
6. Untwist your gauze since you are done with the chin strap and from the left ear continue covering the back-top of the patient’s head by making an arch to the right side. At this point, we recommend taking a piece of tape and using it to secure the gauze and chin strap so its easier to work from side-to-side on the back of the head.
7. Cover the back of the head by sweeping back and forth once or twice, taping as you reach the other side. If you leave a hole exposed for a patient’s finger to slip in and scratch around, you both might regret it.
8. When the entire head is covered with gauze after sweeping back and forth, take another pass around the head where you previously taped over. This helps press the tape down and remain secure. Imagine trying to gift wrap a ball without taking another pass with paper – the tape might lift-off or holes may appear.
9. How many times you wrap may depend on your gauze and its breathability. When your gauze is close to depleting (less than 2 feet or 60cm), tape it down and roll your gauze towards the back of the head where the wires are bundled and wrap the wires using your gauze.
10. After your wire bundle is gently wrapped, bring the last bit of your gauze towards the front center of your patient’s head and tape it down. This way, you know where your head wrap ends. It’s also easier to unravel if you need to replace it or simply need to remove it. Feel free to take some extra tape and place it on the folds for added security.
Some Things to Remember
- You can follow up the EEG head wrap with a stocking cap. If using a stocking cap, tape around the circumference.
- Be very careful not to tape on the top of the leads or wrap too tightly – this can cause a pressure wound. Make sure you can fit two fingers under the wrap to verify it’s not too tight. Ask the patient if they are comfortable.
- Is a head wrap always necessary? No – but for patients who need to sleep during the study, it can be more comfortable. Also, if a patient is having tonic-clonic seizures it can help the leads stay secure.
That’s a Wrap
While many EEG technologists are very experienced performing a head wrap, we recommend having a fellow colleague wrap your head for practice sometime. It’s important to know how the patient may feel if the wrap is too loose or too tight. A little empathy goes a long way. Once you’ve mastered the process, you could probably do this with your eyes closed!
This educational content is brought to you by Lifelines Neuro. Sandy, Madison, and Chris are registered EEG technologists for the Lifelines Neuro Clinical Trials team who offered their combined years of experience to create this article.