How Resourceful Of A Neuromonitoring Tech Are You?

First off, let me start this topic off by saying that I’m not a big fan of the term neuromonitoring tech (I prefer surgical neurophysiologist or SNP). But I really want to address those in the field that might embrace the title of neuromonitoring tech. This person might feel that they are there to set the patient up as prescribed by their company’s policy and procedures. Any changes that need to be made is out of their job description.

That’s not the role of anyone doing neuromonitoring, no matter what you call yourself.

You need to understand what you’re doing, why you’re doing it and when to make changes. You need to be flexible, thoughtful and thorough.

I started off under the tutelage of Joe Danto and systemization of his techniques by Joe Conlon. Joe Danto knows this field like few do. He started his career at a time when adapting due to limitations was necessary in order to get things done. And he was an absolute Maguyver in the OR. Grab 20 yellow wires, slice it, dice it, tape it back together and get beautiful responses.

But having to adapt due to limitations of equipment started to become less of a problem. In comes Joe Conlon and does what he does… makes the difficult easy. With systems in place, he was able to eliminate certain problems and know where to go next if things aren’t as they should be.

I think most groups have adopted their protocols in order to give the neuromonitoring tech the best starting place – most of the time. And I absolutely agree that this should be the way things are done. One of my jobs is to look over current policies and to make sure that they are what is currently considered best practices.

But we shouldn’t devalue the ability of a neuromonitoring tech to adapt. And since a good percentage of oversight physicians spend much less time in the OR compared to the neuromonitoring tech, they may not be the go-to person to ask those types of questions.

One Of Your Tools – The Reference Jumper Cable

You can see the jumper reference cable here (blue and black)

There are plenty of neuromonitoring techs that have gone rummaging through their bags looking for their last green wire to use as the ground and found this (usually) black, double-headed cable and thought to themselves – “what’s with this thingy?”

That thingy (the jumper reference cable) is a nice addition to anyone’s bag. I’d actually request 2 if I were you. I’ve used these a number of times to get me out of a pinch. They don’t always make their way out of my bag, but I do make sure that I have them available in every case.

For the sake of those less familiar, let’s go over some scenarios where the neuromonitoring tech might make use of these in order to better adapt to the case at hand. I’m not going to give every use that I can think of. I’d like to see what else the community can come up with. But here are a few:

1. If you’ve used an older version of the Cadwell MEP box (CV-2), then you’ve used the jumper in order to be able to simulate the right and left cortex using the same 2 electrodes.
2. Using tripolar J-hook electrodes for stimulating a peripheral nerve, you can place both your anodes into the jumper cable and then to your box.
3. If you’re low on electrodes and plan on doing referential recording EMGs, you can save yourself an electrode. For instance, say your monitoring abdominal muscles. Instead of using 4 electrodes, you could use 3 total. 1 in the upper and 1 in the lower. The 1 electrode in the middle abs can be linked to both the upper and lower.
4. You could link M1-M2 and M3-M4 to cover a greater area of stimulation for tcMEP (as far as I know, those doing this technique have yet to publish their findings that you can get threshold at a lower output of electrical current).

There’re 4 ideas on how to adapt your setup using these reference jumper cables. Does anyone else have an example they’d like to share to help make a neuromonitoring tech into a surgical neurophysiologist?