OLYMPIC BRAINZ MONITOR

POLICY
The physician orders continuous Cerebral Function Monitoring (CFM) via Olympic Brainz Monitor (OMB) as an
amplitude-integrated electroencephalography (aEEG) for infants greater than (>) 30 weeks gestational age
with suspected neurological insult or impairment.

Subdermal needle electrodes may be used on infants > 30 weeks gestation.

Note: Subdermal needle electrodes are contraindicated in the event of coagulation abnormalities or hematoma.
Subdermal needle electrodes are removed for an EEG.
Applicability: aEEG using the Olympic Brainz Monitor occuring within the Neonatal Intensive Care Unit.

PROCEDURE
Gather Equipment for Hydrogel Sensors
1. Brainz™ Monitor 6. Nu Prep (skin prepping gel)
2. Olympic Brainz Monitor™ adapter set 7. Razor
3. Neonatal hydrogel sensors, 5 8. Sterile q-tips
4. Standard tip skin marker, 1 (non-permanent marker) 9. Sterile water
5. Medicine cup 10. Sterile 2x2 gauze

Gather Equipment for Subdermal Needles

1. Olympic Brainz Monitor™ Monitor 6. Wrap hat
2. Disposable subdermal needle electrodes 7. Medicine cup
#29 gauge, 4 8. Non-sterile gloves
3. Neonatal hydrogel sensor, 1 9. Paper tape
4. Standard tip skin marker, 1 (non- 10. Sterile cotton tipped applicators (q-tips)
permanent marker) 11. Steri-strip™
5. Dexidin 2 solution 12. Sterile water
13. Sterile 2x2 gauze

Registered Nurse (RN) or Registered Respiratory Therapist (RRT)

To apply Olympic Brainz Monitor monitoring the RN and RRT must have completed the competency
review skills checklist.

Preparation Note
1. Check for physician’s order to initiate Cerebral
Function Monitoring
2. Plug in OBM at bedside OBM takes 15-20 seconds to startup

3. Select "patient" and enter patient information
(Patient ID, Name and date of birth)
4. Assemble OMB monitoring equipment for
hydrogel sensors or subdermal needles
5. Position infant supine with head in neutral
position
Ensures data stored for ease or printing and
retrieval later
Subdermal needle electrodes are contraindicated in
the event of coagulation abnormalities or
hematoma
 Use second person or parents to provide
developmental support for the infant

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Preparation
6. Measure from the tragus to the midline of the
scalp (use sagittal suture to landmark the
midline of the scalp).
Figure 1: Craniosynostosis (Source: Seattle
Children’s Hospital)
7. Mark site for electrode placement with a non-
permanent marker
 Use the same letter on the either side of the
scalp (e.g. if the infant is “C” on the left,
keep it a “C” on the other side of the head)
 Adjust OBM lead positioning to avoid
haematoma or caput succedaneum
8. Mark size on the measuring tape
Procedure
For Hydrogel Sensors: steps 9 to 19
For Subdermal Needles: steps 20 to 29
Hydrogel Sensor Setup
9. Do not shave head for Hydrogel Sensors
10. Cleanse the scalp with sterile water if dirty
11. Cleanse the area with Nu Prep on a q-tip
12. Clean off Nu Prep with sterile water on sterile
gauze, while keeping the hair parted over site
13. Pat area dry
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OLYMPIC BRAINZ MONITOR
Note
Use large tape for full term infants
 Use small tape for premature infants
 Align strip so each end point has the same letter
(A, B etc)
 Ensure that the tape is parallel to the plane
of the face.
 Ensure the tape covers ear during
landmarking process
Ear tragus
Label tape with infant’s name
 Adhere tape to the monitor indicating to the next
nurse where the leads were placed
Note
Fine hair should not need to be shaved:
 Part hair using a comb or toothbrush
 Shave only a small area at the site (if needed)
Infants with vernix or blood present in hair will
require a comb to clean hair prior to sensor
application
Never use normal saline as it will deactivate the
hydrogel sensors
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Procedure Note
14. Part the hair if not done during cleaning
15. Place hydrogel sensor’s electrode circle on the
cleansed site
 Direct sensor wires upwards to the crown of
the head

16. Apply gentle pressure over sensor to facilitate

adhesion
17. Repeat process for remaining sensors
18. Place the reference sensor on the back, chest,
or shoulder and attach to the green lead
19. Place electrodes directly into the data
acquisition box (DAB)
 follow the arrows on the diagram that
corresponds with the electrode positioning
on the baby’s head
Ensure the 2 sensors on each side of the head
do not touch each other
Prep the skin for the reference sensor as for the
hydrogel leads
 Check sensor quality on the Brainz monitor
throughout application
 Ground sensor drying out/poor adhesion can be
reason for poor signal quality
 Sensor indicators should be green

For Subdermal Needles:

20. Do not shave head for needle electrodes
21. Cleanse scalp with sterile water if dirty; use
comb on matted hair
22. Clean using Dexidin 2 solution with mild  Scrub scalp for 30 seconds
friction  Dry for 60 seconds
23. Insert the needles in the scalp in a horizontal
position subdermally

24. Position the electrode anterior to posterior Electrode wires are directed upwards towards the

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Procedure
25. NEVER reinsert needle if it has been
withdrawn from the skin
Do not insert needle into veins or hematomas
26. Secure needles with steri-strip™ at the
insertion site:
 Place steri-strip chevron to secure
 Place one small piece of paper tape over top of
chevron
27. Place the reference (ground) hydrogel sensor
on the back, chest, or shoulder and attach to
the green lead
NEVER use a needle as the reference sensor.
Post Procedure
29. Check sensor indicators periodically
throughout monitoring to ensure green
throughout OBM use
Green = OK, <10kΩ
Amber = Marginal >10-20kΩ
Red = Poor >20Ω
30. Once all sensor indicators are green, initiate
Brainz monitoring by pressing record
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OLYMPIC BRAINZ MONITOR
Note
top of the head
28. Prep the skin for the reference (ground) sensor:
 Cleanse the area with Nu Prep on a q-
tip
 Clean off Nu Prep with sterile water on
sterile gauze, while keeping the hair
parted over site
 Pat area dry
 Never use normal saline as it will
deactivate the hydrogel sensors
 Check sensor quality on the OBM throughout
application
 Sensor indicators should be green
Note
 Poor signal will trigger Amber or Red
indicatorsand an audible tone. Silence alert and
troubleshoot cause.
 To silence an alert when “Signal” button
flashing. Press “signal” button and select
“dismiss” from the popup.
 Always check the ground hydrogel sensor first;
this is often the problem, especially when all the
other sensors are needle sensors.
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Procedure Note

31. Selects 3 electrode or 5 electrode

configuration
Monitoring/Marking and Printing Events
32. MD to Review OBM monitor tracing every 24
hours and complete an aEEG Checklist for
OBM tracing for previous 24 hours.
 Refer to aEEG Checklist, Appendix E
 To Print a report with selected aEEG tracings
see ‘Printing Events/Reports’ section

33. Continue Brainz monitoring for 5 days (120 Remove needle sensors carefully (to avoid a
hours) as per Physician’s Orders needle stick) and place in sharps container.

Marking Events Note

Mark an event when providing care (e.g.  The marker will be placed at the current
administering phenobarbitol, suctioning, diaper cursor timeline location.
changing) to an infant on OBM.  Scroll through the recording to place
markers retrospectively
-
Select “markers/add”:
 Select one of the preselected markers
 A red line will appear in the aEEG display
(use the navigation controls and cursor to add a
marker at a different spot along the timeline)

Creating a Custom marker:

 Touch the custom marker field
 Type in the custom event name and press
“add”

Reviewing Events

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Procedure Note

When Marker has been placed a green marker

line extends down from the event tag, through the
aEEG and Impedance display
- Marker description is visible in top left
- Marker time is noted on the bottom

 Events triggered by the seizure detection

software will appear as a redlines/blocks above
aEEG tracing

Seizure Detection/ Background Pattern Alert

When an area of suspicion is detected by the Seizure detection= Tone + Visual (“Clinical”
OBM the “Clinical” button will turn from green to button flashing)
red and begin to flash yellow/orange with audible
tone. Background Pattern= Visual (“Clinical” button
flashing)
When a change in the background pattern is
detected the “Clinical” button will change from To silence alert:
Green to yellow/orange with no audible tone:  Press “Clinical” button
 Select “Dismiss”
1. Notify MD
2. Place maker for event

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Procedure Note
3. Silence Alert
4. Document event

Printing Events/Reports
Creating a ‘Snapshot’: Events of significance are saved as ‘Snapshots
where they can be copied to a USB key for printing
 Select the scoring view icon
 Select segment of interest
 Press “Report” button
 Label as appropriote
 Select “Save”
Printing a Single aEEG segment ‘Snapshot’:

 Select “reports” and select “snapshot” to

access
 the details page
 Select details to be included in snapshot
(Print Information, CFM Graph, EEG
Graph, Impedance Graph, Marker Text)
 Ensure USB is plugged in to the monitor
 Select save location “USB @ OBM..”
 Select “Copy” to save to the USB key
 Touch the HOME icon on the Main
Taskbar to return to live recording
 Remove USB Key from CFM monitor and
insert in printing enabled computer.
 Open USB file and print.

Printing Multiple ‘Snapshots’:

 Select “Patient”, select “snapshot”

 Press single file icon to change to
multi file select icon
 Select snapshots from list to include in report
 Press “Copy” to save to the USB key
 Select location from pop up window

Suspending/Powering off
34. Suspend the OBM if the infant is moved for a
procedure and Brainz monitoring will need to  Press the button and confirm suspend
be re-started recording
 Once Brainz is suspended data will be saved,
do not unplug without first powering off
 Brainz needles must be removed for an EEG to
be performed

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Procedure Note
 Never unplug the OBM without first powering
35. To Power off OBM first select in the top down or this will cause damage the internal hard
left corner of the screen. Wait until the green drive.
signal light is dark before unplugging.

36. Remove hydrogel sensors or subdermal
needles
37. To restart Brainz monitoring, repeat skin
preparation for both the hydrogel sensors or
subdermal needles
 Hydrogel sensors maybe attached to a piece of
saran wrap to maintain moisture and reactivated
later with sterile water
 Subdermal needles are single use only must be
disposed in sharps container after each use
(always remove subdermal needles for EEGs)
 Press “restart” and “confirm” to restart
monitoring

Documentation
Nursing Flowsheet:
 Hematoma or caput succedaneum
 Type of electrodes applied
 Tolerance of the procedure
 Seizure log

DOCUMENTATION
aEEG Checklist
Bedside Information Tool (BIT)
Nursing Flowsheet
Seizure Log

REFERENCES
Olympic Brainz Monitor. Natus Medical. Retrieved November 13 2015, from
http://www.natus.com/index.cfm?page=products_1&crid=778

Seattle Children’s Hospital. (2011). Retrieved from http://www.seattlechildrens.org/medical-conditions/bone-

joint-muscle-conditions/craniosynostosis/

Back to Neurological Stabilization for HIE

APPENDIX

A. aEEG Checklist
B. aEEG Reference Patterns for Olympic Brainz Monitor
C. OMB Quick Start Guide

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Appendix B.

aEEG Reference Patterns for Olympic Brainz Monitor

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