Embedded Files
1. open the sensor kit
1. open the sensor kit
A sensor kit has the following components:
1. sensor
2. headband
3. wireless charger
4. power source
5. tablet (supplied by client)
ATTENTION - always turn the sensor off for storage and store the sensor in the original case.
2. log into device
2. log into device
Open the brain4care app.
A TRUSTED device enables user login with a PIN. If is not trusted, you will have to log into the brain4care app with a user and password setup previously.
3. assemble sensor
3. assemble sensor
Snap the sensor band to the outer studs only that are nearest to the headband edges (adult configuration).
4. pair sensor to app
4. pair sensor to app
Press & hold the power button on the top of the sensor.
Automatic pairing will occur if the sensor has previously been paired before.
For first-time manual pairing, Tap the (+) button to initiate the sensor pairing procedure.
After successfully pairing the sensor, you can also disconnect or change which sensor is paired with the app.
5. start new session
5. start new session
Tap new session. If it is possible to do safely at this point without delaying the procedure, enter the 4 required fields (Name/DoB/MRN/Sex).
Note: ALL fields can be entered at the beginning, during or the end of the monitoring session.
Sessions with the same MRN and DoB will be linked together in chronological order in all subsequent PDF outputs for trending over time.
6. position patient and sensor
6. position patient and sensor
Positioning PATIENT (IMPORTANT!)
Positioning PATIENT (IMPORTANT!)
Place neck in midline position.
Align body to supine position with head of bed (HoB) at 30°.
Positioning SENSOR (IMPORTANT!)
Positioning SENSOR (IMPORTANT!)
IDEAL placement is on a bony plate with as little tissue/muscle as possible, near positions (A) or (B).
Open the headband by rotating the turnbuckle counter-clock wise. Place the headband on patient capturing as much head-circumference as possible. Over-tighten the turnbuckle clock-wise until the banner is RED. Wait for 5s. If BLUE banner does not appear, loosen turnbuckle one click at a time until banner is BLUE.
headband tightness banner
headband tightness banner
Verify headband tightness with the in-app banner colors / colored LED halo on the sensor.
Yellow - headband is too loose, tighten turnbuckle.
Red - headband is too tight, loosen turnbuckle.
Blue - headband tightness is correct, wait for waveform quality sample collection.
7. verify waveform quality
7. verify waveform quality
A 20s sample will be analyzed. Use the visual guide below for final verification noting uniformity of waves and the grey confidence interval around the waveform.
Blue - adequate signal quality, ok to start monitoring.
Orange - insufficient signal quality, improve headband positioning. Instruct patient to relax, not speak, and avoid movements. Remove any external sources of artifacts.
acceptable examples
acceptable examples
Excellent quality - smooth repeatable consistent waveforms.
Good quality - repeatable consistent waveforms.
Average quality - acceptable waveform with artifacts, slight adjustment recommended if possible.
unacceptable examples
unacceptable examples
Poor quality - excessive artifact and/or lack of uniformity. Improve headband positioning. Instruct patient to relax, not speak, and avoid movements. Remove any external sources of artifacts.
Poor quality - Likely an arterial blood pressure waveform. Reposition sensor to avoid placement on an arterial vessel or tighten the sensor to occlude the vessel with notable waveform improvement.
Poor quality - likely low amplitude waveform. Tightening turnbuckle.
8. monitor values and trends
8. monitor values and trends
Once waveform quality confirmation is sufficient, tap start monitoring.
During a monitoring session you can view:
Patient information
Live waveform tab
P2P1 ratio tab
Normalized Time-to-Peak (nTTP) tab
Clinical events button
Check wave quality button
Pause monitoring button
End monitoring button
clinical parameters
clinical parameters
Assess individualized trending of compliance and risk of intracranial hypertension with the following parameters.*
Estimated P2P1 Ratio
Estimated P2P1 Ratio
When the P2 > P1 it suggests a loss of compensatory reserve mechanisms and deterioration of intracranial compliance. At certain thresholds it can indicate risk of intracranial hypertension.*
P2/P1 > 1.4 has 90% specificity to assess risk of intracranial hypertension (IH)*
P2/P1 > 0.8 and < 1.2 is the baseline threshold for a healthy population*
P2/P1 < 0.8 has 92% sensitivity to rule out intracranial hypertension (IH)*
* refer to publications related to assessment of risk of intracranial hypertension, progression of compliance, and baseline values for healthy population
Normalized Time-to-Peak
Normalized Time-to-Peak
Normalized time to peak is affected by compensatory reserve and intracranial compliance. At certain thresholds it indicates risk of intracranial hypertension.*
nTTP > 0.3 has 92% specificity to assess risk of intracranial hypertension (IH)*
nTTP < 0.3 is the baseline threshold for a healthy population*
* refer to publications related to assessment of risk of intracranial hypertension, progression of compliance, and baseline values for healthy population
Surrogate ICP Waveform
Surrogate ICP Waveform
The live surrogate ICP waveform shows intracranial dynamics, the interplay between intracranial pressure and compliance.
observations / clinical notes
observations / clinical notes
Tap observations to enter time-stamped physiological/medical information or patient event/changes.
Use this fast data entry option to select clinical interventions or to record clinical events.
Contact your brain4care representative if this menu is not available to you.
pause function
pause function
Use pause monitoring when patient/sensor repositioning is required or when patient movement/clinical event necessitates a pause.
The pause function pauses data collection to not include excessive artifacts into a monitoring session.
quality check
quality check
Tap waveform quality at any time during the monitoring session to verify the quality of the waveform.
This quality check is the same one used during initial sensor positioning.
9. end a monitoring session
9. end a monitoring session
1) Tap end monitoring.
2) Tap confirm.
3) Ensure the 4 required fields are entered (Name / MRN / DoB / Sex)
If required by your institution, tap report category and make a selection.
4) Tap confirm to finalize monitoring session.
10. disinfect the sensor
10. disinfect the sensor
Power off the sensor and disinfect the device following your institution's normal medical equipment disinfection methods (ethyl/isopropyl ETO 70-90%/CHG Wipes/ Etc.)
ATTENTION - Only apply light pressure on the patient-facing sensor disc.
Detach headband from sensor ensuring to also disinfect the studs.
ATTENTION - the sensor is not water proof, do not submerge.
11. charge sensor
11. charge sensor
Place the sensor with the logo facing upwards on the charging cradle. A full charge = 10hr of continuous operation. It takes 2hr for a full charge.
ATTENTION - the halo LED will pulse green when the sensor is appropriately placed in the cradle and the battery is not over heating.
WARNING - Use only the original power supply and cables to prevent the charger from malfunctioning.
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