The “Nuts and Bolts” of How to Do an EEG

What to do before you begin EEG recording and monitoring

With a myriad of EEG products and application methods to choose from, how do you make the best possible choices for you and your patient? In this month’s Tech Tip, you’ll see the necessary supplies and best practice application techniques to help you achieve a successful EEG study every time – as recommended by EEG technologists. Some prior knowledge and experience will be needed, but here’s effectively how to do an EEG.

• Skin prep – An abrasive prep is used to lower the impedance of the electrode connection by cleaning the area of oils and dried skin where the electrode will be applied. The skin will be slightly abraded, so use caution if your patient has sensitivity. There are several brands available, such as Nuprep, Lemon Prep, Skin Pure, etc. There are different price points and advantages to consider, while some technologists just prefer a certain type due to familiarity.

• Conductive paste – This serves as a medium to adhere electrodes to the scalp and to ensure lowering of the contact impedance at the electrode-skin interface. Typical routine pastes include Ten20 and Elefix. This paste can be used alone for routine studies because it is easy to remove. If used alone, it is not recommended to use for LTM recordings. For LTM studies, a stronger hold conductive paste/gel is suggested like Tensive, SAC2 and EC3. Collodion is also a tried and true option, although the odor is quite strong. Facilities may require air circulation when using Collodion, so using it may not always be an option. 
• Cotton tip applicators – to apply the skin prep. For best results, apply in a single direction. Alcohol wipes can assist in addressing difficult impedance issues, such as oils, hair products, and patients with a very dry scalp.
• Kerlix roll and Tubular Elastic Retention Netting – these are an option for EEG head wraps and securing electrodes.

• Cling gauze – to wrap the head after electrodes are secure. Having additional types of gauze can be useful for other applications as well. No matter if you are using Kerlix, Tubular Netting, or Cling gauze, the best practice is to use the least amount of wrap required to make sure the electrodes are secure. If it’s too thick or tight, the patient will be uncomfortable and sweat. This causes the paste to melt and break down the patient’s skin.

• Surgical marker – Used to mark the head during electrode measuring. Single-use markers like a surgical marker are recommended due to regulations regarding cross-contamination.

• Tape measure (paper or cloth) – to measure the head. If your measuring tape is reusable, we recommend removing the tape from the dispenser reel so the tape can be cleaned. You don’t want particles trapped in the reel!

• Gauze squares or cotton balls – may be used to cover the individual electrodes and help them stay in place. These can be used with any of your conductive pastes/gels, and even collodion.
• Skinsavers – reduce pressure from electrodes and can help prevent skin breakdown, but may not be right for every patient. Use on a case-by-case basis.

• Tape – Silk, paper, Transpire, Coban, or Hypafix tape. Hypafix tends to hold tight and is usually the tape of choice when securing electrodes to the skin (not recommended on hair).  Silk tape also works well.  Paper tape should be avoided for long term exams.
  • Silk and Transpore tape are useful in securing headwraps, while Coban is useful for bundling electrodes.

Now you’re done! Well… not really. This is just a simple how-to, but it’s a start.

As technology changes, technologists have adapted their workflows, too. The days of massive computers on wheeled carts are thankfully behind us, allowing improved service to patients. If you enjoyed the information in this article, you may enjoy our article on preparing your patient for an in-home EEG recording. Join our Lifelines Neuro mailing list to receive updates about EEG tech tips or other helpful information of your choosing.