BIS Monitoring Guideline - Medical Center Intranet

GUIDELINES FOR BIS
MONITORING TECHNOLOGY
UTILIZATION IN THE HVC
Owner: HVC Originated: 1/2006
Location / File name:
Reviewed:
Legal Review:
Revised:
PURPOSE: Provide guidelines for BIS Monitoring Utilization in the Heart and Vascular Center
GUIDELINES:
Indications for Use:
BIS monitoring should be considered for the following patients:
1. Mechanical Ventilator Therapy
●Utilize BIS monitoring to assure sedation level is appropriate for the anticipated
progression of ventilator therapy.
2. Sedation level under which the patient cannot be assessed clinically
●i.e. moderate to deep states of sedation
●BIS monitor is used to guide interventions to minimize potential awareness, pain,
anxiety or over sedation...
3. Other patients as identified by specific physician order.
PROCEDURE:
Initiation of BIS Monitoring:
BIS monitoring use may be nurse-initiated. BIS monitoring does not require a physician order.
Implementing BIS Monitoring:
Sensors have a 12-month shelf-life with the expiration date on the sensor package.
Documentation Standards:
The BIS Numeric Region or BIS index score will be documented on the Moderate Conscious
Sedation flow sheet with the vital signs prior to patient stimulation and every 10 -15 minutes during
the procedure. BIS Value is 0 to 100.
0 = Flat line
20 = Burst suppression
60 = Low probability of explicit recall
80 = Responds to loud commands
100 = Wide awake
Guidelines for BIS Monitoring Utilization in the Heart and Vascular Center
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The following sensor values should be considered when assessing the validity of the BIS index score
but does not have to be recorded on the nursing record.
●Signal Quality Index (SQI):
Indicates quality of EEG signal over the last 63 seconds
Check Sensor skin contact if SQI decreases
●Electromyograph (EMG):
Indicates presence of muscle activity or other high-frequency artifacts (oscillating ventilator modes,
convective warming blanket, fluid warmer, oscillating air mattress)
BIS value is optimal when EMG is absent of minimal, increased EMG may elevate the BIS value.
EMG may occur as a result of pain, lightening sedation, and/or NMB wearing off.
●Suppression Ratio Value (SR):
Indicates the % of time in the last 63 seconds that the EEG signal is suppressed, (↑SR = ↓ BIS and vice
versa). Helpful for monitoring the level of EEG suppression during drug-induced coma management.
●Burst Count (Bursts/min):
Another method of quantifying suppression that provides a measure of the number of EEG bursts per minute. A
parameter (in addition to the SR) that indicates the percent of time over the last minute that the EEG is suppressed.
Also helpful for monitoring the level of EEG suppression during drug-induced coma management.
Considerations for BIS interpretation in the HVC:
1. Clinical judgment should always be used when interpreting the BIS in conjunction with other
available clinical signs.
2. BIS readings should be interpreted in response to stimulation, and in the context of patient
status and treatment plan.
3. Patient movement (EMG) may occur with low BIS values.
4. Patient movement (EMG) may indicate inadequate analgesic level.
5. Artifacts and poor signal quality (SQI) may lead to unreliable BIS values. Potential artifacts
may be caused by poor skin contact, muscle activity or rigidity, head and body motion,
sustained eye movements, excessive interference (nerve stimulators, warming devices, air
mattresses, etc.) Check sensor adherence and reprep sensor circles, review analgesic timing,
reposition other medical equipment, move away from interference.
6. BIS values should be interpreted cautiously in patients with known neurological disorders, in
those taking psychoactive medications and in children less than 1 year old.
Guidelines for BIS Monitoring Utilization in the Heart and Vascular Center
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