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Artifact Recognition and Troubleshooting Focus 2017
Artifact Recognition and Troubleshooting Focus 2017
Troubleshooting
2017 Focus Fall Super Session
The Best of the Best For Respiratory Therapists and Sleep Technologists
The Doubletree Hilton Hotel
Pittsburgh, PA
Grant/Research Support
Consultant
Speakers’ Bureaus
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3. The material presented in this lecture has no relationship with any of these potential conflicts, OR
4. This talk presents material that is related to one or more of these potential conflicts, and the following
objective references are provided as support for this lecture:
1.
2.
3.
OBJECTIVES
1. Physiology, Instrument and environmental artifacts
2. Discuss and demonstrate the appropriateness of filter changes vs.
referencing
3. Recognition of high frequency artifacts
4. Recognition of low frequency artifacts
5. Troubleshooting
WHAT'S KEY TO AN ARTIFACT FREE RECORDING
4
PHYSIOLOGIC VS. NON-PHYSIOLOGIC
• Heart • Electrical
• Muscles • Impedance
• Eyes • Noise
• Sweat • Electrode Popping
• Respiratory
NOT ALL ARTIFACT IS BAD
• SNORING ARTIFACT: helps identify sleep onset
• If artifact is localized to just one channel, it typically indicates the problem lies
with one electrode.
• CLINICAL JUDGEMENT
Eye Movement
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Verify Eye Movement
NOTE: positive part of the eye (the cornea) rotates closer to the right EOG electrode,
resulting in a downward deflection. When the eyes open they rotate down, resulting
in an upward deflection in the right EOG channel. Voluntary blink artifact in the
frontal channels is slower and much higher in amplitude than the spontaneous
EOG Artifact in EEG seen in biocals.
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Eye Movement Facts
• Drowsiness and Stage 1 are noted to have slow rolling eye
movements.
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Eye movement in the EEG, during REM
Normal phasic twitching of legs during
Normal variation in respirations associated with REM.
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ECG Artifact
• This artifact is prominent in patients who are obese or have short, thick necks.
• This occurs most often when using a referential montage, particularly if the
input impedances are unbalanced.
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ECG artifact in EOG, EEG, & EMG.
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ECG ARTIFACT FIX
• Solution #1: Re-apply these leads by raising the placement higher up on the
mastoid (behind the point of the ear) to minimize the artifact
• Solution #2: Double-reference M1 and M2 to minimize the ECG artifact
• Any M1/M2 artifacts will now contaminate all linked channels
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DOUBLE REFERENCE
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Cardiac Oscillation
• This artifact often occurs during prolonged central apneas and it is often
incorrectly considered to indicate a patent airway.
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Cardiac-oscillation in the flow channel
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Glossokinetic Potentials
• The tongue, like the eye, is electrically charged. The tip of the tongue is
more negative than the root.
• The movement will change the electrical field around the face; this artifact
in the EEG is call a glossokinetic potential.
• Commonly seen in very young patients and is due to sucking or chewing.
• Document what the patient is doing.
• Elimination of the artifact is difficult.
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INFANT SUCKING ON PACIFIER-ARTIFACT EEG
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Infant Sucking-EEG clean
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Muscle Artifact
• Caused by localized muscle activity in the vicinity of an exploring or
reference electrode. Common in tense or anxious patients.
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Movement artifact, associated with bruxism
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MOVEMENT IN SLOW WAVE SLEEP
Muscle artifact in EOG & EEG
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Electrode “Pop”
• May simulate a spike or sharp wave.
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Bad Ground-popping
Movement artifact
Chin popping
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M1 electrode popping
Leg lead popping/off
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No.
ELECTRODE “POP” FIX
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Causes of 60 Hz
• High Electrode Impedances
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Vagal nerve stimulator, cycling on for 7
seconds and off for 15 seconds.
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60 Hz Artifact-Fix
1. NOTCH Filter (Leg EMG)
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Movement Artifact
• This artifact occurs most often during a position change but can also be produced by limb
movement or the characteristic head, neck and mandible movements seen in OSA.
• Patient movement may cause electrode popping and amplifier blocking artifact, particularly if
an electrode becomes loose during the study.
• In many cases, movement artifact can be useful when scoring events because it helps to
identify arousals when accompanied by an EEG frequency shift.
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Movement Artifact Seen in EEG
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Awakening-movement artifact
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Movement Artifact-Fix
• Usually disappears when patient falls asleep.
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Respiration Artifact
• Respiration artifact in the EEG and EKG appears as a low frequency
baseline sway that occurs in phase with the respirations. It is mostly
positional.
41
Respiratory artifact primarily in M1 & ECG
Leg electrode popping.
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Respiratory Artifact in M1
60 Hz in legs
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Respiration Artifact-Fix
• The LRR in the EEG/EPG can be raised from 0.3 to 1Hz to decrease the
slow wave artifact—document and address when able.
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Sweat Artifact
• Sweat artifact is best described as a low frequency baseline sway that often
affects one or more channels.
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Sweat Artifact in the EOG & EEG
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Sweat Artifact-Fix
• Try to cool the patient, either by reducing the room
temperature or removing a blanket.
b. ECG Artifact
c. Paradoxical Breathing
QUESTION 2:
What’s occurring in this picture?
B. ECG Artifact
Seen in M1 and M2
QUESTION 3 : WHAT IS OCCURING?
a. Electrode popping
b. No nasal/oral airflow
sensor
c. Paradoxical breathing
d. All the above
Question 3 Answer
ALL THE ABOVE