iEEG Protocol

Setting up patient day after surgery

  1. Obtain postop MRI from Radiology and upload to UCSD (/home/halgdev/incoming/iEEG_NYU/)
  2. Obtain surgeon sketch and EEG montage from EEG techs and email to Thomas
  3. Create patient definition files on Nspike, following previous patient files in Desktop>nspike_defn_files>patient_defn_files
  4. Set up splitter box at patient bedside. Detailed protocol: Nspike_protocol_splitterBox.pdf
    1. For each group of the splitter box, connect the colorful leads to the left parallel port (goes to clinical system) and connect the preamp to the right parallel port and connect the other end to the corresponding parallel port on the satellite box (‘Master’ for 1-4 and ‘Slave’ for 5-8), connect enough boxes so all extra channels are accounted for
    2. Splitter box sits in the duffel bag on the satellite box at the patient bedside
    3. Following the electrode order on the montage, plug the lead from the patient’s head into the splitter box and the corresponding colorful lead into the clinical system jack box.
    4. Make sure ground and ref electrodes are transferred from the clinical to the splitter box as well, jump G1 and REF as needed. New splitter box: jump G1 (REF connected on inside). Old splitter box: jump G1 and REF
    5. Double check the clinical display that channels are being displayed correctly every so often.

Before entering patient’s room

 

Night before running task

  1. Set Nspike to “Charge Battery”
  2. Charge Dell Presentation laptop
  3. Charge other equipment if needed. ex: Jasper movie task laptop and speaker

 

Day of task, setup in office

  1. Need on nspike car:presentation laptop, (any other hardware ex. speakers, microphone, camera, video monitoring laptop)
  2. Connect presentation laptop:
    1. Make sure it is charged
    2. In Desktop/ieeg-data folder make copy of task folder with ptID in name
    3. Restart in Stimulus mode
    4. Open presentation by opening the .exp file in task folder
    5. Plug in Parallel Port Cable – for triggers to be sent.
    6. If using Mac presentation laptop, connect parallel port cable to silver box and usb to laptop for triggering
  3. Power down Nspike and disconnect from wall
  4. Read task sheet in “Pt. Task Instruction” binder
  5. Get patient binder, task report forms:  Recording_Materials_redux.doc

If you are running Speech, or a task that requires video/audio recordings, set up the following as well

      1. Connect microphone
        1. Plug in “audio out”
      2. Connect camera
        1. Plug in “handycam power”
        2. Plug in “handycam video out”
      3. Connect video monitoring laptop:
        1. Connect to power
        2. Plug in “ADVC to laptop” and “firewire drive data” cables
        3. Turn on, open “Capture” shortcut on desktop and hit F5 (hit “skip all” on prompt)
        4. Check that video drive isn’t full

 

Inform staff

  1. Inform EEG techs in the control room that we are starting research 
  2. Inform nurses at front nurse’s station that we are starting research 
  3. Tape laminated “Research: Offline Data-Acquisition in Progress” card on monitor of patient at nurse’s station 
  4. Inform nurses in AMU that we are starting research 

 

In patient’s room

 

Setup at bedside

  1. Before rolling in Nspike, check that patient is ready.
  2. Plug in Nspike using shielded extension cord, and turn computer on.
  3. Connect Nspike to Satellite box
    a. plug in fiberoptic (orange) cable
    b. plug in power cables
  4. Set Nspike battery to “Use”, lights should start flashing
    1. if not: Battery not set to “Use” or battery is not charged
    2. NSpike is not properly connected to satellite box: reconnect all plugs
    3. Once you switch to “Use” make sure to check that the clinical system is still recording properly. If not  then set to  off, unplug all of the preamps from the satellite box. Set battery to “Use”, make sure the clinical is recording properly, then plug in the preamps one at a time. Check the clinical again when everything is plugged in.
  5. Setup Nspike computer
    1. Start Timecode (on Desktop) – only needed if recording video
    2. Start Nview (on Desktop)
    3. Select patient definition file
    4. Select experiment definition file
    5. Nview might freeze here – this is a bug. Shut down Nview and restart.
  6. Hit “Run/Stop” to start acquisition.
  7. If you are recording video, check Timecode and audio input on Nview
    • Switch to viewing 2 channels, select Timecode-Audio channels, change scale to timecode-audio
    • Tap the microphone and check for a signal
    • Watch for a burst on Timecode every 10 second   
      • if no Timecode is present, close Timecode window and restart
      • if still not present, restart the Timecode and Nview
      • if still not present, check that the white box is turned on and switch the timecode splitter connection between the red and white end
  1. Check that signal on all channels is present
    1. Switch scale to 150, and view 32 channel and cycle through all 8 sets of 32 (each set represents 1 group on the splitter box) if signal isn’t present or doesn’t look right, replug preamp cables
  1. To reduce 60Hz noise, Unplug everything possible from around the patient
    1. These include: bed, IV, DVD player, TV, chargers, cell phones, etc
    2. Make sure the fiberoptic data cable does not cross any power cables.
    3. Make sure the power cable does not touch the frame of the bed.
    4. Do not unplug patient monitoring device, above patients bed.
  2. Clear off everything from patient’s table and set laptop in front of them and set up any necessary response interface hardware (ex. mouse).  Make sure the laptop screen and the response interface is a comfortable distance from the patient.
  3. Ask patient if they are sitting comfortably, and let them know that they should not move during the experiment, since it introduces artifacts.
    1. bring back of bed up so they are sitting upright, make them comfortable
    2. position cables, so patient does not have to move them during task
  4. Explain task to patient, do practice run if necessary

 

Running Task

  1. Checklist:
    • All channels have a signal on Nspike
    • Trigger cable is connected to presentation laptop.
    • Everything is unplugged from around the patient
    • Staff knows you are doing research
    • Task on laptop is ready to be run
  1. Start Nspike recording
    • hit “Start Recording” button
    • File name should follow format: NY111_090714_FWIO_01 (PtID_YYMMDD_task_run#)
    • Start video recording, use same file name and hit red record button
    • Note file names and folder on report form
  1. Run task.
  2. Make sure you have triggers being sent in the Matlab window.
  3. Periodically check that all channels are still recording, and note any changes in noise.
  4. Fill out report from, and note anything out of the ordinary.

 

In the event of a seizure

  1. Inform the nurse immediately.
  2. Plug the bed back in.
  3. Remove the stimulation laptop and miscellaneous research devices from the patient’s immediate vicinity.
  4.  Ensure that all of the cables involved in collecting the data are not affected by the seizure or clinical personnel. Do not stop recording, though try to make the patient as accessible as possible to the nursing staff.
  5. Once the seizure has run its course shut down the NSpike and leave the room.
  6. For immediate seizure video-data syncing for clinical viewing:  Seizure Data Video Syncing

 

When task is finished

  1. Stop recording
    1. On Nview: click “Stop recording” and wait for pop-up box indicating file finished saving
    2. Stop recording on video monitoring laptop.
  2. Either start setting up the next task, or finish recording session and disconnect Nspike.
  3. Remove all other equipment from the patient care area  (except satellite box and splitter box connections, when possible), plug all electronic devices in that you unplugged around patient’s bed and inform the nurse that you’re finished. Collect all of the ‘Research…’ signs.
  4. Close all windows on the N-Spike and shut down the computer. Unplug from the satellite box and power strip. Return to the N-Spike corner and plug into power outlet and Ethernet. Turn on the N-Spike. Set battery to charge

 

Patient bedside tips – For better quality data

  1. To minimize patient movement: 
    1. Before starting task, make sure patient is sitting comfortably, in a position he/she can keep throughout the task.
    2. Adjust bed/pillows as necessary
    3. Make sure cables are comfortable for patient, to avoid him/her repositioning them during task.
    4. Explain to patient, that it is important to minimize movement, since it introduces artifacts.
  2. Clear everything off of patient’s table, to avoid spills and minimize distractions. 
  3. Draw curtain, to avoid visual distractions. 
  4. Clearly state instructions, and indicate which hand/finger should be used for the response, and where patient’s attention and sight should be directed. 
  5. While patient is running task, every once in a while you can give the encouragement or a thumbs up, which should improve patient performance. 
  6. If the AMU is busy/loud, close the door and post sign “Testing in progress, please enter quietly”.

** make sure to pick up medication summary from the nurses in the AMU while the patient is still on the unit. In their software, click the printer icon, in the drop-down menu choose “Print Documents” and print the 7 day medication summary.