National Competency Skill Standards for Performing Electroencephalography (EEG)

Electroencephalography (EEG) technologists practice in accordance with the facility policy and procedure manual which details every aspect and type of recording.

ASET – The Neurodiagnostic Society presents this document to provide the national criteria for evaluating competencies for neurodiagnostic technologists performing EEG.

The elements for quality patient care and interaction as well as basic knowledge and technical performance are covered. The technical components include those defined in the American Clinical Neurophysiology Society (ACNS) 2016 Guideline 1: Minimum Technical Requirements for Performing Clinical EEG published in the Journal of Clinical Neurophysiology, Volume 33, Number 4, August 2016.

Section I: EEG Core Knowledge Statements

The neurodiagnostic technologist who performs EEG procedures (referred to as EEG technologist in this document) has the knowledge base to interact with the patient and obtain a quality, interpretable EEG recording that will yield information about the brain’s neuronal activity. The technologist possesses the appropriate knowledge level of diseases to correlate patient history and clinical symptoms to determine appropriate maneuvers to be performed during the EEG.

Technical Skills and Other Abilities:

1.1 The EEG technologist provides a safe recording environment by:

• Verifying identity of patient per institutional protocol (e.g., two patient identifiers).
• Inquiring about any allergies or skin sensitivities prior to electrode application process.
• Disinfecting electrodes after each procedure according to established best practices, facility protocols, with consideration for using disposable products¹.
• Following standard precautions for infection prevention according to facility protocols¹.
• Observing patient safety and comfort protocols as established by facility protocols.
• Maintaining current certification in basic life support (BLS) and following facility protocols for respiratory or cardiopulmonary crisis.
• Following HIPAA policy and facility procedures for cybersecurity and safety of electronic records.
• Recognizing/responding to life-threatening situations.
• Following facility policy and procedures for safety procedures, patient isolation and sedation.
• Complying with facility policy and procedures for emergency and disaster situations and with hazardous material handling procedures according to safety data sheets (SDS).
• Maintaining instrument/equipment in good working order, including annual biomedical safety checks.
• Taking appropriate precautions to ensure electricalsafety making sure no wires are frayed, extension cords are not in use, 3-pronged grounded plugs are in use; and damaged cords and outlets are reported and removed from use until properly repaired according to facility policy and procedure.

1.2 The EEG technologist establishes rapport with the patient and the patient’s family/caretaker by:

• Using personal communication skills to achieve patient relaxation/cooperation.
• Explaining all test procedures including activation procedures.
• Explaining the electrode application method (paste, collodion, etc.).
• Interacting on a level appropriate for patient’s age and cognitive ability.
• Maintaining respect and patient confidentiality.

1.3 The EEG technologist evaluates the patient to:

• Assess cognitive abilities, mental state, and comprehension level, such as following commands, understanding the procedure.
• Note the patient’s overall physical condition.
• Determine appropriate method of electrode application.^{2, 3}
• Ascertain the patient’s capacity to cooperate with activation procedures.
• Determine if hyperventilation/photic stimulation is contraindicated.
• Accommodate for disabilities or special needs.
• Determine the need for additional physiological monitors.
• Recognize, respond to and document behavior suggestive of seizure or nonepileptic event.
• Determine the possible need for assistance or emergency intervention.

1.4 The EEG technologist prepares patient demographics that include:

• Patient’s information (name, age, medical record number, DOB, referring physician, etc.)
• Recording time, date and technologist’s name or initials
• Pertinent patient history and familial medical history
• Previous EEG reports
• Current medication/sedation and time of last dosage
• Time of last meal
• Time, date, aura and circumstances of last seizure or symptoms
• Patient’s mental and behavioral status and consciousness states
• Diagram of skull defects or anomalies (if any)
• Diagram of any modifications in electrode placement

1.5 The EEG technologist follows a method of electrode application that includes:

• Following the American Clinical Neurophysiology Society (ACNS) guidelines for head measurement, utilizing the International 10–20 and 10–10 Systems for electrode application.
• Assessing skin condition of the scalp prior to electrode application.
• Adjusting electrode placement for anatomical defects or anomalies.
• Properly cleaning the electrode site to reduce skin impedance prior to scalp electrode application. ^{2, 3}
• Applying surface electrodes with EEG conductive paste or with collodion and electrolyte and utilizing additional techniques to appropriately and safely secure electrodes as needed (i.e., headwrap).
• Verifying surface electrode impedances measure below 10 kΩ and are balanced.
• Applying and appropriately securing electrodes to record ECG.