Placement of nerve monitoring electrodes

[littleds]

I work in a surgery center, recently the pre-op nurses were told that we must place nerve monitoring electrodes on patients prior to their spine surgery. Supposedly the electrodes help the surgeon identify when he/she is too close to a nerve so that they do not damage it during the surgery. Myself and several other nurses do not feel comfortable placing the electrodes on the patients. Are there any other nurses out there doing this? If not would you feel comfortable placing nerve monitoring electrodes on patients prior to a spinal surgery?

[ewattsjt]

I am a CST going back for an ASN. I work at a hospital and I do quite a few spines (all day on Thursday and Fridays). It does help the surgeon to identify when the pedicle probe or screw is to close to the nerve root. When we use the system(s) there are specifically 2 to 3 OR nurses who have been trained by the rep in the positioning of the leads that go to pre-op and do it. In fact we use two different monitoring systems; one uses sticky electrodes and the other uses percutaneous needle leads. Correct lead placement (into the area the root affects and not getting (L) vs ® mixed up) as the patient will be prone is a must; as the monitor uses milliamps to determine how close they are to the nerve root. It alarms when close and it tells what side is affected. There should be an accompanying book with the system that shows correct lead placement and the leads are color coded. At a minimum I would ask for an in-service on it and a copy of the lead placement book.

I hope this info was at least somewhat helpful.

[justjenny]

anytime a case is boarded with nerve monitoring the hospital contracts an outside company to come in and apply the electrodes and they also monitor the screen, etc. and communicate with the surgeon.

I believe at other hospitals in the area they have people in house that are specially trained but I wouldn't personally TOUCH those electrodes without a full orientation/training on their use!!

Jenny

[KayceeCA]

At the hospital where I circulated spine cases (a teaching hospital) the surgical residents placed the electrodes. I definitely would not place them without proper training.

[jwk]

Just personal opinion, but....

Y'all are absolutely nuts if you are involved in placing these electrodes for the surgeon. Training from a "factory rep" is worthless. What will happen if the surgeon screws up, cuts a nerve, paralyzes the patient, and then says "The OR nurse must have screwed up placing the monitoring leads". In these spine cases, when something bad happens, you're looking at major $$$ lawsuits. I'd be willing to bet that if you carry personal nursing malpractice insurance, this would be outside the scope of coverage.

There are companies that do this on a daily basis. Insist that your hospital use them, or that your surgeon place the monitoring wires themselves (which many ENT surgeons due with facial nerve monitoring).