Cardio-respiratory polygraphy studies are performed to assess whether a patient has sleep disordered breathing. Sleep disordered breathing may be obstructive or central in nature, or there may be a mixed picture. Cardio-respiratory polygraphy studies and also to monitor the effectiveness of interventions such as ventilation.<\/p>\n
This protocol is for cardio-respiratory polygraphy using the following sensors:<\/strong> Setting Up an In-patient On-Line Study<\/strong><\/span> Laptop<\/strong> For overnight nursing staff on the ward<\/strong><\/span> Sensor Application – <\/strong>the diagragm below should help in positioning sensors correctly<\/p>\n ECG<\/strong> Overnight monitoring<\/strong> Setting up a home study<\/strong><\/span> When sensors are in place:<\/strong> Downloading a study<\/strong><\/span> Trouble shooting<\/strong><\/span> Other Signals<\/strong> Cardio-respiratory polygraphy studies are performed to assess whether a patient has sleep disordered breathing. Sleep disordered breathing may be obstructive or central in nature, or there may be a mixed picture. Cardio-respiratory polygraphy studies and also to monitor the effectiveness of interventions such as ventilation. This protocol is for cardio-respiratory polygraphy using the following sensors: […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":586,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"","meta":{"nf_dc_page":"","footnotes":""},"class_list":["post-638","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.uhwchildren.com\/respiratory\/wp-json\/wp\/v2\/pages\/638","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.uhwchildren.com\/respiratory\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.uhwchildren.com\/respiratory\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.uhwchildren.com\/respiratory\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.uhwchildren.com\/respiratory\/wp-json\/wp\/v2\/comments?post=638"}],"version-history":[{"count":5,"href":"https:\/\/www.uhwchildren.com\/respiratory\/wp-json\/wp\/v2\/pages\/638\/revisions"}],"predecessor-version":[{"id":2399,"href":"https:\/\/www.uhwchildren.com\/respiratory\/wp-json\/wp\/v2\/pages\/638\/revisions\/2399"}],"up":[{"embeddable":true,"href":"https:\/\/www.uhwchildren.com\/respiratory\/wp-json\/wp\/v2\/pages\/586"}],"wp:attachment":[{"href":"https:\/\/www.uhwchildren.com\/respiratory\/wp-json\/wp\/v2\/media?parent=638"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\n\u2022 Pulse oximeter
\n\u2022 Transcutaneous CO2
\n\u2022 ECG
\n\u2022 Nasal flow pressure transducer
\n\u2022 Thoracic effort band
\n\u2022 Abdominal effort band
\n\u2022 Position sensor<\/p>\n
\nSOMNOBox<\/strong>
\n\u2022 Put a fully charged battery into the SOMNOBox for the study.
\n\u2022 When conducting an on-line study the SOMNObox needs to be connected to the laptop. There are 2 different systems for this, one is wired , the other is wireless.
\n\u2022 For the wired system, plug the USB lead into the laptop and connect it to the grey and white connector box. Then connect the grey and white connector box to the blue SOMNObox with the \u2018telephone wire\u2019 connection.
\n\u2022 For the wireless connection the blue transmitter box needs to be plugged into the blue SOMNObox and then the black receiver box with the aerial needs to be connected to the laptop via the grey serial port cable and the serial port USB converter. The black receiver box also needs to be connected to the mains.
\n\u2022 When setting up the study, if the laptop does not pick up a signal try changing the USB port and initializing again.<\/p>\n
\n\u2022 Switch on the SOMNObox by pushing in the second \u2018O\u2019 of the word SOMNO.
\n\u2022 Open the DOMINO panel on the laptop and select \u2018On-line study\u2019.
\n\u2022 Enter patient data
\n\u2022 click \u2018next\u2019.
\n\u2022 Ensure \u2018Paed PSG TOSCA (17)\u2019 is selected and \u2018On-line mode\u2019 is selected,
\n\u2022 click \u2018next\u2019
\n\u2022 Select \u2018Auto start\u2019, and then input start date and time. (if this is greyed out, make sure the SOMNO box is switched on or change the USB port if using the wireless system)
\n\u2022 Click OK
\n\u2022 The live screen should now come up but with no traces.<\/p>\n
\n\u2022 Everything up this point will be set up by the sleep physiologist or respiratory nurse and brought to the ward.
\n\u2022 When you are ready to start up the study, place patient sensors on and after the selected start time has passed the sleep study waveforms should appear on the screen,
\n\u2022 You need to click \u2018start recording\u2019 to record the study.
\n\u2022 Check all sensors are recording.
\n\u2022 During the night regularly check the waveforms and document that they are functioning on the supplied paperwork. If any signal is lost check\/adjust cables and bands and connections.
\n\u2022 In the morning stop the recording by selecting \u2018Stop Online Mode\u2019 from the \u2018File\u2019 menu and then confirm all warning messages. Do not turn off the blue SOMNObox.<\/p>\n
\nThe ECG electrodes need to be stuck onto the chest as shown in the diagram. Then the lead needs to be plugged into the yellow<\/span> slot marked EXG.
\nChest Band<\/strong>
\nThe chest band fastens firmly around the chest in line with the nipples using the velcro.
\nConnect the band to the SOMNObox by clipping the leads onto the 2 \u2018snap\u2019 connectors and plug into the orange<\/span> slot labeled AKT.
\nAbdominal Band<\/strong>
\nMake sure you have the correct band size for the patient: (Grey \u2013 Extra small, Red – Small. blue – Medium, Black – Large,Yellow \u2013 Extra large)
\nThe abdominal band fastens firmly around the stomach inline with the navel. Sizes are as above. Connect to SOMNO box in the same way as chest band and plug into the dark green<\/span> slot labeled ABDO.
\nPosition sensor<\/strong>
\nThe position sensor is applied to the front of the chest band using velco. It is important to ensure it is the correct way up and in the centre of the chest. Plug into the blue SOMNO box slot marked PLM1.
\nOxygen Saturation Probe<\/strong>
\nThe oxygen saturation probe fastens securely to the finger or toe over the nail bed. Plug into the red<\/span> SOMNO box marked SpO2.
\nNasal Cannula<\/strong>
\nConnect the nasal cannula via luer lock to the pressure interface on the CPAP sensor. Then connect the black coloured plug to the socket on the SOMNOscreen box marked CPAP. Lastly fit the nasal cannula sensor to the patient\u2019s face with the prongs sitting just under the nostrils and secure with the sliding attachment. Tape can also be used across the cheeks to keep in place.
\nTOSCA<\/strong>
\n\u2022 The TOSCA must be plugged in to the mains power at all times.
\n\u2022 The scart lead and separate power plug connects to the back of the TOSCA and then another lead connects this box to the SOMNObox into the light green<\/span> slot labeled AUX.
\n\u2022 The TOSCA should display on the front screen that it is \u2018READY TO USE\u2019.
\n\u2022 The ear clip should be used for older children (usually over 7 years) and the white chest stickers for younger children (under 7 years).
\n\u2022 To use the ear clip, remove packaging and peel off the white paper revealing a sticky area. Attach the ear clip to the earlobe (take care to avoid any piercing holes if possible), gently squeeze and hold in place for about 20 seconds to secure position.
\n\u2022 Remove the black sensor from the \u2018autocal\u2019 slot. Place one drop of the contact gel onto the sensor and clip the sensor onto the ear clip.
\n\u2022 If using the chest ring sticker, place it on the chest under the collar bone and then connect the sensor with contact gel in the same way.
\n\u2022 It takes approximately 10 minutes for the TOSCA to warm the site up enough for the CO2 reading to accurate, after 10 minutes has passed, if the PCO2 value is less than 2.5Kpa it suggests that the sensor has not been applied properly. In this case unclip the sensor, wipe off the contact gel with a dry cloth and put it back into the \u2018auto cal\u2019 slot until it reads \u2018READY TO USE\u2019 again. When it is ready start the process again using a new ear clip or ring. This same method should be used if the sensor comes off in the night.<\/p>\n
\n\u2022 The sleep study nurse is responsible for applying the sensors and setting up the patient for the sleep study, regular checking of the signal quality and adjusting the sensors accordingly.
\n\u2022 As well as completing the observation chart it is important that the sleep study nurse makes note of any other events they feel are relevant such as snoring and desaturations (duration, and lowest level).
\n\u2022 Accurate documentation of information from the sleep study is paramount as this is important for the sleep physiologist analysing the study. It is important to document if the patient had any ventilation or oxygen overnight, which settings they were on and the time these were used.<\/p>\n
\n\u2022 Initialise Flash Card
\n\u2022 Switch on lap top and plug in USB card reader.
\n\u2022 Insert smart card into reader.
\n\u2022 Open the \u201cDOMINO panel\u201d and click the \u2018initialize\u2019 button.
\n\u2022 Enter the patients data.
\n\u2022 Click \u2018next\u2019.
\n\u2022 Ensure \u2018manual start\u2019 is selected with a duration of 12hrs.
\n\u2022 Click \u2018next\u2019.
\n\u2022 Ensure \u2018Paed PSG TOSCA (17)\u2019 is high-lighted and DE-SELECT \u2018online mode\u2019.
\n\u2022 Click \u2018Initialise Flash Card\u2019
\n\u2022 When it has formatted, safely remove the flash card and place it back in the SOMNO box for the study.
\n\u2022 Put a fully charged battery into SOMNOBox for the study.<\/p>\n
\n\u2022 Turn the power on the SOMNOBox by pushing in the second \u2018O\u2019 of the word SOMNO on the sleep box and hold it in until the screen lights up with a \u2018flashing marker\u2019.
\n\u2022 Press the red arrow under the screen 4 times allowing the screen to change each time you press. This will scroll through pre test checks and then finally starts the recording.
\n\u2022 When the recording has started there should be real time recordings for % SpO2 and pulse rate on the screen. It will record for 12 hrs and then automatically turn off.
\n\u2022 If the child wakes up before the screen has turned off, just remove leads – DO NOT switch off the box before it has finished and DO NOT remove the smart card as this will DELETE the sleep study.
\n\u2022 If you do need to stop the sleep study early and it is not possible to just \u2018let it run\u2019 press all three buttons on the front together and hold down for a few seconds, then select \u2018cancel\u2019 (using arrows and confirm using the enter button) and then confirm \u2018sure\u2019 in the same way. The recording will now be stopped.<\/p>\n
\n\u2022 Remove the flashcard from the SOMNO box and insert it into the card reader. Open the DOMINO panel and select \u2018Download\u2019. Check the patient details are correct and then click \u2018download\u2019.
\n\u2022 When the study has downloaded, open the SOMNO panel and select \u2018Analyse\u2019, open the study which has just been downloaded and then in put details of the study e.g. ventilation settings used etc. in the Tools menu and then patient info.<\/p>\n
\nTOSCA<\/strong>
\n\u2022 If the TOSCA probe comes off during the study, wipe the probe with a dry cloth and put it in the \u2018autocal\u2019 slot for calibration. Only place the probe on the patient when the screen displays \u2018READY TO USE\u2019.
\n\u2022 If the screen displays \u2018Too Much Ambient Light\u2019 the ear clip needs repositioning.
\n\u2022 If the screen reads \u2018Movement Artifact\u2019 this simply means the patient is moving and once they settle this message should go.
\n\u2022 If the screen is requesting \u2018Renew Gas Bottle\u2019 continue overnight monitoring and inform the Respiratory Nurse or Sleep Physiologist the following day.
\n\u2022 If the screen displays \u2018Remembrane Sensor\u2019, follow these steps:
\n\u2022 Press the DOWN ARROW once and the word MENU should be highlighted.
\n\u2022 Then press the + key
\n\u2022 Press the DOWN ARROW until PCO2 PARAMETERS is highlighted.
\n\u2022 Then press the + key
\n\u2022 Continue to press the DOWN ARROW 3 times until SPECIAL PCO2 PARAMETERS is highlighted
\n\u2022 Then press the + key
\n\u2022 Continue to press the DOWN ARROW a further 5 times until SENSOR REMEMBRANED? +YES+ Is highlighted.
\n\u2022 Then press the + key and the machine will record as normal
\n\u2022 If this procedure had to be followed please inform the Respiratory Nurse or Sleep Physiologist the following day.<\/p>\n
\n\u2022 If any other signals fail, check connections and adjust sensors.
\n\u2022 If bands fail make sure they are tight enough but do not cause discomfort, if there is still no signal try another size or spare band and report it on the observation chart.<\/p>\n","protected":false},"excerpt":{"rendered":"