Users Manual Part 1

46
Nerve Integrity Monitor
System set-up
Operating room set-up
The NIM VitalSystem Nerve Monitor has a few characteristics that need to be taken into consideration when setting up the
operating room (OR). Some of these characteristics include, but are not limited to, external devices, trac patterns, sterile areas,
color-coding, grounding, and muting detection.
Position the unit so that it does not obstruct the power source for the purpose of disconnecting the Main voltage by the power
cord. Set the NIM VitalSystem on a table or NIM cart located about three meters from the surgical eld, but as far as possible from
the electrosurgical unit. Consider trac patterns and sterile areas. The surgeon may have additional preferences as to location and
visibility.
Typical Set-up
1
8
3
97
2
4 6
5
1 Anesthesia Equipment
2 IPC
3 Nursing Supplies / Surgical Instruments
4 Scrub Nurse
5 NIM Vital
6 Surgeon/assistant
7 Surgeon
8 Electro Surgical Unit
9 Anesthesiologist
Anesthesia requirements
All decisions regarding anesthesia are the responsibility of the attending licensed medical practitioner administering the anesthesia.
Because all intraoperative monitoring discussed in this User’s Guide requires that EMG activity be recorded from a muscle or
muscles, it is important that the muscle(s) not be paralyzed during the surgery or at least during those parts of the surgery when the
nerve(s) being monitored is (are) deemed at risk by the surgeon. It is important that the surgeon discuss these issues pre-operatively
with the attending licensed medical practitioner administering the anesthesia.
Note: The use of paralyzing anesthetic agents will signicantly reduce, if not completely eliminate, EMG responses to direct or
passive nerve stimulation. Whenever nerve paralysis is suspected, consult an anesthesiologist.
Patient Interface setup
Prior to surgery, you must setup the patient interface box. You may use the NIMVital system to support the process of determining
which nerves to monitor and positioning the electrodes appropriately. Refer to the “View electrode placement using the Help
screen” topic for additional information.
Clip the patient interface box near the surgical site within reach of the sterile electrode leads and sterile stimulator cable(s). Position
it so that it is out of the way of the doctor and the scrub nurse.
Placement of the electrodes should be performed by a physician or under the direction of a licensed medical practitioner who
determines the particular nerves that are at-risk with each particular patient and procedure. Place the recording electrodes in
the muscles innervated by the at-risk nerves. The electrode sites should be cleaned with alcohol to remove oils from the skin. The
electrode needles are inserted into the patient, taped into position, and the wires routed away from where the surgeon will be
working. Usually, recording electrodes are placed before the sterile eld is draped and dened. Never let the recording electrode
needle leads contact one another.
Two electrodes per monitoring channel and one ground are required. The electrode pairs for each channel plug into color-coded
input jacks on the patient interface. The polarity of each channel does not matter for eective monitoring unless you want the wave
form inverted.
Always locate the ground and stimulus return electrodes in a non-innervated, electrically neutral area (electrically neutral areas are
where the bone is close to the skin and the electrode will not contact muscle tissue [sternum]). The ground should also be located
between the stimulus return and recording electrodes.
Route the white (+) stimulus return wire (monopolar) away from the channel electrode wires.
FCC use only, not for Medical use