TRAINING
ORIMtec was originally incorporated in 1999 as an educational organization. We recognized the need to better train medical professionals who could provide IONM services in the operating room (OR). The quality of IONM for spinal and cranial surgeries varies dramatically from one provider to another, covering the spectrum from maximal to minimal standards. Neurotechnologists (NTs) who are board-certified in neurophysiological monitoring, including MDs, PhDs and END/EEG technologists, and those who can provide high-quality, comprehensive IONM services are few in number.

Physicians interested in having surgical monitoring available for their patients needed access to a qualified technical staff. In response to the critical need for well-trained monitoring personnel, ORIMtec has developed a comprehensive program to train and prepare NTs who are highly skilled in using IONM.

An individual’s current level of medical education and experience would determine the additional training required for him or her to pursue a career in IONM. For example, someone with a background in electrophysiology might need additional knowledge of surgical procedures, image interpretation and surgical instruments. An operating room nurse (CNOR) would benefit primarily from training in electrophysiology and its application to surgical procedures.

With a successful education program in place, ORIMtec began to offer IONM services directly. Today, providing NTs well trained in surgical monitoring who can support physicians, patients and hospitals remains our most important function.

Training Qualifications
ORIMtec has focused its unique approach on providing the level of training and medical education required of the best NTs. Knowledge of electrophysiology, while important, is only part of the equation. ORIMtec NTs receive extensive training in operating room and surgical protocols, anatomy and physiology, and practical applications of IONM. We have found that NTs who demonstrate proficiency in these areas will provide the most comprehensive intraoperative monitoring available, ensuring the highest level of care.

ORIMtec protocols require comprehensive multimodality monitoring of numerous neural structures through closure of the surgical procedure.

• The NT must be able to identify all wave forms and problem solve appropriately.
• When neurophysiological responses fall outside defined limits, proper problem solving enables each NT to determine whether the cause is surgical, related to anesthesia or of another origin.

TRAINING PROGRAM

To prepare NTs to perform at this level of excellence, ORIMtec staff developed a comprehensive training program. This internal curriculum currently consists of five training modules and related topics:

Operating Room Orientation
Operating room protocol
The OR can be a hostile environment for those with minimal IONM experience. Numerous personnel perform various tasks during setup and throughout the surgery. The NT must be aware of each team member’s function and know how to work with each individual. ORIMtec NTs follow the Association of Operating Room Nurses (AORN) Standards, Recommendations, Practices, and Guidelines.

Sterile technique
Sterile field contamination presents a common problem in the OR. Contamination of the sterile field can delay a surgery significantly. Delays increase the danger to the patient by increasing the time under anesthesia and elevate the cost of the procedure. An experienced NT with knowledge of sterile technique will minimize the possibility of sterile field contamination.

Anatomy and Physiology
Surgical pathology and anatomy
Knowledge of surgical pathology and anatomy enables the NT to properly prepare the patient for monitoring before surgery begins. Once the procedure is underway, it is difficult and sometimes impossible to add additional electrodes that might be needed for the NT to monitor neural structures not identified prior to the start of the surgery.

Basic understanding of X-Ray/CT/MRI images
Basic understanding of X-ray, CT or MRI images helps the NT understand the surgical pathology and anatomy for electrode placement during patient preparation. Knowledge of surgical pathology enables the NT to converse intelligently with the surgeon as to the surgical plan and possible deviations.

Surgical Protocol
Surgical procedures
Thorough knowledge of the surgical procedure enables the NT to monitor the correct neural structure with the appropriate modality at any given time. All too often, when an NT does not possess this knowledge a negative outcome occurs because the NT instituted the inappropriate modality or monitored the incorrect neural structure.

Anesthetic variations
Knowledge of how anesthetic variations affect the quality of recordings is critical. The successful NT must learn a vast amount of information about this topic, which constitutes an entire class in itself.

Surgical instruments
Surgeons generally do not narrate what they are doing while operating. The NT must learn about surgical instruments so that he or she will be aware of what the surgeon is doing by observing the instruments in use.

Internal fixation devices
The well-trained NT will thoroughly understand how an internal fixation device is used. This knowledge enables an NT to properly prepare and monitor a specific structure with the appropriate modality.

Electrophysiology
Monitoring modalities
There are numerous modalities specific to each surgical procedure. The NT must be capable of incorporating the appropriate modality at any time.

Practical Applications of IONM
Sensitivity to strategic location of the neurotechnologist station
The well-trained NT must set up his or her station proximate to both the surgeon and anesthesiologist to observe the surgical instruments and anesthetic concentrations being used. Positioning the station away from electrical interference is also critical.

Correlation of modalities to surgical procedure
Knowing what modality to incorporate at any given time enhances the NT’s ability to identify a neurological deficit before it becomes detrimental to the patient.

Communications
In addition to having all the necessary knowledge, the NT must be able to communicate with the surgeon and anesthesiologist in an informative, timely manner. While communicating during surgery would appear to be an easy task, this skill becomes absolutely necessary when tension in the operating room reaches its peak.

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