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Lutheran Medical Center opens VEEG unit for children

Nurses promote safety, comfort while pediatric patients undergo brain test for functionality, electrical activity

Monday November 7, 2011
At a recent nurse.com Nursing Spectrum roundtable, Maureen Liberth, RN (from left), pediatrics nurse manager and clinical nurse specialist of women's and children services, Eileen P. Williamson, RN, senior vice president, Nursing Communications & Initiatives, and Jonor Espiritu-Santiago, RN, nurse instructor, behavioral health, discuss the new VEEG unit at Lutheran Medical Center.
At a recent nurse.com Nursing Spectrum roundtable, Maureen Liberth, RN (from left), pediatrics nurse manager and clinical nurse specialist of women's and children services, Eileen P. Williamson, RN, senior vice president, Nursing Communications & Initiatives, and Jonor Espiritu-Santiago, RN, nurse instructor, behavioral health, discuss the new VEEG unit at Lutheran Medical Center.
(Photos by Janice Petrella Lynch, RN, MSN)
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As part of the pediatric unit, Lutheran Medical Center in Brooklyn, N.Y., opened an inpatient video electroencephalographic monitoring unit for children last fall. The unit admits children up to age 18 for 48 hours.

Because the continuous, 48-hour VEEG provides information on brain functioning and electrical activity, testing gives a clearer picture of which medications effectively can maintain a child who is having seizures, particularly if the medication needs to be modified or changed. "If we are tapering a medication, the VEEG also shows us whether there is an increase in brain activity as a result of the tapering," said Maureen Liberth, RNC-OB/EFM, MSN, pediatrics nurse manager and clinical nurse specialist of women's and children services.

During inpatient VEEG, patients safely can be taken off medications that might mask seizure activity during a routine EEG. The studies are long enough to overcome sampling effects of shorter-duration EEG studies and the nonspecific findings that may incorrectly suggest or refute a diagnosis of epilepsy.

"Before we opened the unit, we knew that our top priority was to educate ourselves about seizure disorders," Liberth said. "Because seizure disorders manifest themselves differently in children, our epileptologists and pediatric neurologist have held regular inservice programs and case conferences to help us understand the issues and interdisciplinary plans for the patients and their families who come to our VEEG unit."

Staff learned how to monitor and care for patients who experience a seizure while being tested and to implement emergency interventions for any patient who experiences prolonged seizure activity. After the seizure, staff ask patients to repeat specific key words that were said during the seizure to assess the patient's level of consciousness during the episode.


From left, Sheron Christie, RN, pediatrics, assistant nursing care coordinator; Rosanne Raso, RN, senior vice president, patient care services and CNO; Elaine R. Meyerson, RN, assistant vice president, clinical informatics and nursing recruitment/retention; and Rowena Miranda, RN, assistant director, clinical informatics, participate in a Nurse.com Nursing Spectrum roundtable.
Safety and comfort

Before patients are admitted, they receive a letter from Liberth and the pediatric staff that explains what the patients and families need to know and do before and during the hospital stay. The children's beds are padded, a parent is asked to stay with the child at all times and patients wear baseball caps or scarves to secure the electrodes while undergoing the VEEG.

To create a more comfortable environment, staff encourage children and adolescents to bring their own toys, and there is a recreation room that has games, books and a computer. The children can participate in these activities while being monitored to pass the time.

"Most of the time our children do not feel sick and when they are not sleeping, they need to be kept busy," said Sheron Christie, RN, pediatrics, assistant nursing care coordinator.

Nursing staff members see patients who may have seizures because of a brain tumor or patients whose comorbidities include autism, Down syndrome or chronic post-brain trauma.


Janice Petrella Lynch, RN, MSN, is a regional reporter. Send letters to editorNY@nurse.com or post a comment below.
VEEG facts

EEG-video monitoring is used as a diagnostic tool for recurrent seizures and unconfirmed seizure diagnosis.

VEEG refers to continuous EEG recordings for a prolonged period with simultaneous video recording of the clinical manifestations. With a correlation of the recorded behavior (video) and the EEG activity, the diagnosis of seizures or nonepileptic attacks can be made in most cases.

VEEG-video monitoring provides answers as to whether episodes are epileptic seizures. If an episode is an epileptic seizure, the type can be determined; if it is not an epileptic seizure, further testing can be done to determine the cause. VEEG also can help differentiate epileptic seizures from nonepileptic seizure mimics, such as psychogenic nonepileptic attacks and organic seizure-mimics, such as syncope and parasomnias.

Continuous behavioral and EEG monitoring over time in an inpatient setting helps localize seizure focus, determine seizure type and quantify the number of seizures. VEEG also can differentiate seizures from psychologically-based seizure-like episodes and from physiologic events that may be confused with epilepsy. Examples of conditions with symptoms that may be confused with epilepsy include anxiety disorder, cardiac arrhythmias, migraines, vasovagal syncope and transient ischemic attacks.