Skin irritation and even injury are all too common in long-term EEG monitoring. Some argue they are simply inherent to the procedure, but new research has zeroed in on some key risk factors.

With this information in mind, EEG technologists will now be able to identify their most vulnerable patients and implement enhanced safety measures, decreasing their rate of injury.

Understanding the Research

The authors of the study, published in the most recent issue of The Neurodiagnostic Journal, looked at patients undergoing ambulatory electroencephalography (AEEG) monitoring. The 251 patients studied fell into two groups, those monitored for two to three days and those monitored for four to five days.

As expected, the longer patients wore the electrodes, the more skin inflammation was observed, especially between the second and fourth or fifth days.Inflammation was also greater in patients with the following characteristics:

  • Increasing age
  • Fair skin color
  • Dry skin texture
  • Fine hair texture

Two other factors were associated with increased skin irritation, but only on certain parts of the scalp. “Female gender was revealed to be significant for the frontal domain only, and eyeglasses were shown to be significant for the temporal domain only,” the study’s authors note.

The research took place in an outpatient clinic in Sydney, Australia, and the EEG technologists used many of the skin safety measures outlined in the ASET Position Statement on Skin Safety During EEG Procedures.

The application and removal of electrodes was performed per industry standards. After skin preparation, EEG electrodes were sealed with collodion glue. Patients monitored for more than three days returned to clinic on day two for repositioning. Upon full completion of the monitoring, the electrodes were removed using acetone solution, olive oil, and hair conditioner.

Enhanced Safety Measures

The authors expressed concern that the chemicals used – collodion glue and acetone – may contribute to skin irritation. For more-at-risk patients, they recommend considering alternative products: EC/EC2 conductive cream in place of collodion and water-soluble products in place of acetone, for example. They also suggest placing electrodes 5 millimeters higher in the temporal region for eyeglass wearers. Tubular elastic bandage or tubular elastic net bandages were also recommended because they provide equal and consistent pressure across the scalp.

No matter which products are used, it is important to read and follow the manufacturer’s instructions. According to the ASET Position Statement, “products and electrodes have less impact on skin safety than the technique in which they are used.”

ASET has several other recommendations for working with patients at higher risk that the researchers in the study did not follow. Here are two examples:

  • “Very thin, delicate skin may tolerate the preparation more safely by using clean gauze wrapped around the fore finger with the skin preparing agent and gently massaging the marked area.” A cotton swab was used in the study.
  • “If using collodion-applied electrodes with a thin conductive agent, caution should be taken when filling the electrode cup. A blunt needle tip can easily over-abrade the skin causing injury to the skin surface.” A blunt needle tip was used to inject conductive gel in the study.

Read the full position statement for more skin safety measures.

While the researchers did follow many of skin safety recommendations, they did not treat their study population as high risk. If they had, there might have been a reduced incidence of skin irritation or injury. There is great benefit, though, in discovering risk factors in a more general population. With this information in hand, EEG technologists can adapt their techniques when appropriate, and potentially make skin injury not so inevitable after all.