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.
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.