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BIS
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Catalog excerpts

BIS - 1

REFERENCE GUIDE USING THE BISPECTRAL INDEX (BIS™) MONITORING SYSTEM FOR CRITICAL CARE REFERENCE GUIDE

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BIS - 2

The BIS™ brain monitoring system generates a processed EEG parameter that provides a direct measure of the effects of sedatives on the brain. The BIS™ monitoring value is represented as a number from 0 to 100 that is calculated from the raw EEG obtained by a sensor placed on a patient’s forehead. The BIS™ value is used in a variety of settings — including anesthesia, critical care, and procedural sedation — to provide objective information about an individual patient’s response to sedative drugs. Definition of key terms: • Sedation: The reduction of anxiety or stress by the administration...

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BIS - 3

ASSESSING COMFORT SEDATION Anxiety/consciousness ANALGESIA Autonomic/somatic responses MUSCLE RELAXATION Movement ICU sedation: A bipolar challenge Inadequate sedation may result in oversedation or undersedation. Each is associated with negative consequences. ∙ Patient unable to participate in care ∙ Delayed weaning pneumonia ∙ Ventilator-associated Increases in: ∙ - Unnecessary testing - ICU and hospital length of stay - Costs ∙ Anxiety, agitation Increases in: ∙ - Use of neuromuscular blocking agents - Risk of recall/awareness of unpleasant events - Unintended removal of medical

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BIS - 4

Anxiolysis Moderate sedation Deep sedation Titration of sedatives to the BIS™ monitoring ranges should depend on the individual goals for sedation that have been established for each patient. These goals and associated BIS™ monitoring ranges may vary over time and in the context of patient status and treatment plan.

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BIS - 5

The BIS™ monitor provides a direct measure of the effects of sedatives on the brain. In the critical care setting, the BIS™ monitor is commonly used to allow objective assessment of sedation during: • Mechanical ventilation • Barbiturate coma • Bedside procedures • Neuromuscular blockade The BIS™ monitoring system is most useful for patients who are chemically paralyzed and/or moderately to deeply sedated. Muscle activity may interfere with reliable BIS™ monitoring performance. Important information for using BIS™ monitoring in the ICU • Reliance on the BIS™ value alone for sedative...

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BIS - 6

BIS™ value Displays the current BIS™ monitoring value (0 to 100). BIS™ trend Displays the BIS™ monitoring value over time. EEG waveform Shows real-time raw EEG. EMG (electromyogram) Depicts presence of muscle activity or high-frequency artifacts. When present, interpret BIS™ monitoring value with caution; assess source of artifact. SQI (signal quality index) Indicates the quality of the signal over the last 63 seconds. May be shown as a bar graph or numerically. SR (suppression ratio) Indicates the percentage of the last minute that the EEG signal was suppressed. Burst suppression refers to...

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BIS - 7

SMOOTHING RATE Although raw EEG data is acquired and displayed in real time, the BIS™ monitoring value — a processed EEG parameter — is calculated as a rolling average using a moving window of time. This “smoothing” is necessary to prevent excessive fluctuations. Smoothing rate (or averaging time) is the period (e.g., 15 or 30 seconds) over which artifact-free data is analyzed to calculate the BIS™ value. Smoothing Rate Effects on BIS™ Monitoring Real Time The smoothing rate effects include: ∙ Decreased variability ∙ Decreased delay of general case trends ∙ Easier discernment to state ∙...

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BIS - 8

Note: During these situations, the BIS™ value should be interpreted cautiously and within the context of clinical events.

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BIS - 9

Has the use of any mechanical device that could generate high frequency activity (e.g., warming blanket, oscillator ventilator) been initiated, or is any such device (or power cords) in close proximity to the BIS™ sensor (or BIS™ power cord) or monitor? Artifacts in the higher frequency ranges can artificially increase the BIS™ value. Check EMG bar for presence of high-frequency artifacts. If possible, move offending device away from BIS™ sensor, and plug power cords into separate outlets. Could the patient be in In the REM sleep pattern, the low amplitude/ REM sleep? high frequency...

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BIS - 10

Note: During these situations, the BIS™ value should be interpreted cautiously and within the context of clinical events.

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BIS - 11

BIS™ EXTEND SENSOR Extended performance in consciousness monitoring Accurate and precise measure of level of sedation Resistant to artifact/EMG Sensor application 1. Wipe skin with alcohol and dry. 2. Position sensor diagonally on the forehead: At center of forehead, approximately 2 inches (5 cm) above bridge of nose Directly above eyebrow On temple, between corner of eye and hairline 3. Press edges of sensor to ensure adhesion. 4. Press and hold firmly for 5 seconds. 5. Insert sensor tab into patient interface cable.

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BIS - 12

Impedance checking Impedance refers to the electrical resistance of the skin surface to each of the electrodes in the BIS™ sensor. Combined impedance values must be below a certain threshold for the BIS™ monitor to provide a reading. • Impedances (sensor connection to skin) are tested automatically at start-up. • Impedances can also be manually tested. Depending on your monitor, Sensor Check will be on the main screen. If not, press Menu and go to Sensor Check. In both cases, the screen will provide the status: PASS — Impedance is good. HIGH — High impedance. Re-prep (see below). NOISE —...

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BIS - 13

BIS™ monitoring will not begin until all impedances are acceptable Re-prep sensor — For problem element(s), repeat circling and pressing (steps 4 and 5). If unsuccessful, lift sensor and repeat steps 2 to 5. During BIS™ monitoring — If the Re-prep sensor error message appears, a connection problem has been detected. Run the manual impedance check (see above), identify suspect elements, and correct. BIS™ Extend Software Settings. When the BIS™ extend sensor is connected to the BIS™ monitoring system, the Extend mode is turned on in the System Configuration menu. The following settings...

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