Patient Hookup Procedures

LEARNING OBJECTIVES
1. Understand the importance of the international 10/20 system.
2. Learn the EEG measurements for sleep studies.
3. Learn the electrode sites for the face and body.
4. Learn how to properly apply electrodes for optimal recording.
 Patient Hookup Procedures
Sleep Technologist Preparation:
Prior to patient arrival, sleep tech must:
1. Arrive at the Sleep Center or lab earlier than the pts. (6:30PM for adults,
5:30PM for pediatric pxs)
2. Verify order
3. Review patient information
4. Ask px’s medications (Insulin infusion, Nasal decongestants, Asthma or
heart medications)
5. Prepare the questionnaires (Berlin Questionnaire, STOP-BANG
questionnaire or any hospital based assessment)
Patient Hookup Procedures
 Materials:
✔Scissors, tape measure, EEG marker, medical tape, cotton-tip swabs, gauze
2x2 squares, conductive paste, EEG electrodes (gold cup)
Patient Hookup Procedures
Patient Hookup Procedures
 Patient Hookup Procedures
International 10/20 System
● Dr. Herbert H. Jasper developed the international 10/20 electrode
placement system in 1949 as a standard measurement tool for
placing electrodes on the head for recording electroencephalograms
(EEGs).
● This system of measurement uses anatomical features such as the
ears and the bridge of the nose as landmarks to begin measurement.
● Electrode sites are then found by measuring distances between these
landmarks and using percentages of those distances rather than
specific lengths.
● When measuring for a full EEG hookup, as many as 256 electrode
sites may be used.
● However, for a standard sleep study, only six electrode sites are used
for exploring electrodes, and another three or four sites are used as
references or ground, depending on the type of equipment used.
 Patient Hookup Procedures
Electrode Placement for Sleep Studies:
● When measuring for electrode placement for a standard sleep study, the American
Academy of Sleep Medicine (AASM) recommends the following electrode sites: F3 ,
F4, C3, C4, O1, O2, M1, M2, Cz, Fz, or Fpz (often used as ground and main
reference)
Option 1: Placement for EEG (Electrodes in a Standard Sleep Study)
Step 1: Locate the Four Landmarks. The EEG measurement process begins by
locating four landmarks on the head:
1. Nasion
2. Inion
3. Left pre-auricular point
4. Right pre-auricular point
Patient Hookup Procedures
 Patient Hookup Procedures
Other Electrode Sites:
Electrooculogram (EOG) Electrodes
● The electrooculogram (EOG) leads are placed 1 cm laterally and 1 cm up or
down from the outer canthus.
● The canthus is the corner of the eye, or the point at which the eyelids
meet.
● The recommended placement for adult patients is to place the right EOG
(termed E2) 1 cm laterally and 1 cm up from the right outer canthus, and
the left EOG lead (E1) 1 cm laterally and 1 cm down from the left outer
canthus.
● These are both referenced to the same lead, usually M2.
● An alternate EOG hookup is to place both EOG leads 1 cm laterally and 1
cm down from the outer canthus of each eye.
● In children, the EOG electrode placement may be reduced to 0.5 cm
laterally on each side because of the smaller size of the face.
Patient Hookup Procedures
 Patient Hookup Procedures
Chin Electromyogram (EMG)
● The EMG channels used in polysomnography have bipolar derivations
in that the signal is derived from two active (exploring) electrodes.
● To record muscle activity at the chin, three chin electromyogram
(EMG) leads are placed.
● The first lead is placed in the middle of the chin, 1 cm above the
inferior edge of the mandible.
● The other two are placed below the inferior edge of the chin.
● One should be placed 2 cm down and 2 cm to the left of the midline,
and the other 2 cm down and 2 cm to the right of the midline.
● For pediatric patients, the measurements are often reduced to 1 cm
● above and below the mandibular edge and 1 cm to the right and left
of the midline.
Patient Hookup Procedures
 Patient Hookup Procedures
Airflow Sensors
● Two airflow sensors—a thermal device and a pressure transducer
cannula—are placed directly in front of the nose and mouth. These
devices detect airflow from both the nose and the mouth.
 Patient Hookup Procedures
Snore Sensor/Microphone
● The snore sensor or microphone is usually placed directly on the center
of the patient’s throat.
● Snore microphones detect the sound of the snore and should be placed
at a location where the snoring can be heard.
 Patient Hookup Procedures
Electrocardiogram (ECG) Leads
● Sleep study montages must use at least a single channel, two-lead
electrocardiogram (ECG).
● The ECG provides a display of the electrical activity of the heart. In a two-lead ECG
hookup, one lead is placed directly under the middle of the right collarbone and the
other is placed on the lower left side of the ribcage.
● The exploring electrode is the lead on the lower left, and the reference is the lead on
the upper right collarbone.
● This provides an upright lead II monitoring ECG signal. An additional ECG lead may
be placed under the middle of the left collarbone. This can serve as a backup
electrode should one of the other two become dislodged during the study.
● Using three electrodes provides the opportunity to display two additional
waveforms of the heart rhythm (leads I and III). All three waveforms will portray
upright p waves, QRS complexes, and T waves in patients with normal heart
rhythms.
Patient Hookup Procedures
 Patient Hookup Procedures
Leg EMG Leads
● Two electrodes are placed on the outside of the lower half of each leg.
Specifically, they should be applied to the middle of the anterior tibialis
muscle so they are 2–3 cm apart.
● Foot and leg movements are best detected from this muscle.
 Patient Hookup Procedures
Respiratory Effort
● Detection of respiratory effort is most commonly accomplished with the
use of effort belts that are stretched around the chest and abdomen.
 Patient Hookup Procedures
Positional Therapy Belt
- can be observed directly or may be monitored by a body position sensor.
- it should be clipped onto the thoracic respiratory belt
 Patient Hookup Procedures
Oximeter Finger Sensor
● The finger sensor for the oximeter is placed on the tip of any of the three middle
fingers.
● On one side of the device is a red light; on the other side is a sensor that reads the
red light. These two must be aligned with each other, on opposite sides of the
fingertip.
● Any fingernail polish should be removed because it can inhibit the oximeter’s ability
to accurately detect the oxygen level in the blood.
Patient Hookup Procedures
 Patient Hookup Procedures
Helpful Strategies for Sleep Technologists
● Following are helpful strategies that many technologists
have found helpful in the patient hookup process.

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