[l-andrée]

How do YOU use neurostimulator on your barbituric coma induced patients??? There seen to be a different way for every nurse where I work and I did not find anthing helpfull in any reference book.

Thanks a lot!

[Janet Barclay]

We don't, for that very reaon

[sikevin]

we have an entire protocol for nerostimulator use in neuromuscular blockade, with lead placements and documentation. We don't do this that often so I have to go find it each time

[l-andrée]

Thanks Sarah!
We actually are trying to make a protocol for neurostimulator. In your protocol, do you use the stimulation of the temporalis muscle (at the tip of the eyebrow) or the ulnar muscle (at the wrist, in straight line with the little finger) most?

[JGJBoyz]

we use a peripheral nerve stimulator on all of our patients who are in chemically induced paralysis.
we have neuromuscular blockade protocol that encompasses the pns protocol.
we use the ulnar nerve...we place 2 electrodes ~2 inches apart on the inside of the forearm just above the wrist vertically on the little finger side (ensuring the area is clean, free of hair etc)
we use the train-of-four (usually with ~40-50Mas) to determine level of paralysis, with 1-2 twitches (adductions) of the THUMB (twitching of the fingers doesn't count) being the goal.
if more than 2 twitches are elicited, the medication is tritrated up and reassessment occurs q15min until the desired level is reached. if no twitches are elicited, the medication is titrated down, again with reassessment occurring q15min until the desired level is reached.
once the desired # of thumb adductions is reached, reassessment occurs q4hrs, unless of course there is a need for titration again.
ideally, a baseline assessment would be documented, but usually the patients we receive from the ED or post-op have already been medicated with the blockade when we get them.
when the blockade is discontinued, q15min assessments are done until 4 of 4 adductions of the thumb are seen, especially, if extubation is in the near future.
hope this helps,
jgjboyz