Observations and documentation while on CSA
While on compressed spectral array a daily CSA events log form should be completed by the bedside nurse and any event that could affect the CSA tracing must be documented on the form. This will allow the CSA tracing to be interpreted retrospectively and changes to the CSA in response to an intervention determined and also changes due to artefact disregarded.
Events that should be recorded include clinical seizure activity (with a description of this recorded), clinical finding that maybe in keeping with possible seizure activity e.g. dilated pupils, tachycardia, hypertension, ↑ICP, and interventions such as sedation bolus or new/altered rate of sedation infusion or administration of an antiepileptic drugs should be documented. Also any source of artefact most also be documented such as electrode adjustments, patient movement, handing for physiotherapy, patient cares or suctioning etc. The start and stop time of any event should be recorded along with a description of the event. The importance of accurate recording of the events is vital to interpreting the CSA as without this patient movement could be misinterpreted as seizure activity and unnecessary treatment given.
To go with the events log a record of the actual CSA tracing should be obtained by the bedside nurse every hour on the hour by clicking on the ‘Print Report’ button in the bottom left hand corner. If successful a message ‘Printing to Database’ will appear and a report will print to the printer in the equipment store.
This will generate a report of the CSA for the last hour, together with a brief recording of the current raw EEG tracing and current values for SEF, TP and impedances.
On receipt of this report the impedance levels should be checked to insure they are below the set impedance limit. If not the montage should be brought up (see Setting up the CSA for details) to identify the problem electrode and this should be reapplied.
The previous hours CSA tracing should then be annotated using the daily ‘CSA event log’ before being filed with other printouts in the patient’s CSA folder.
Example of a completed CSA events log
Annotations to the hourly CSA report using the above events log