EMG/NCV Studies: Comprehensive Protocol Guide

Pre-Procedure Requirements

Patient Preparation

• Verify patient identity and study indication
• Review medications (especially anticoagulants)
• Check skin temperature (32-34°C)
• Clean skin with alcohol wipes
• Position patient comfortably

Equipment Setup

• Calibrate EMG machine
• Verify electrode impedance
• Prepare disposable needles
• Set appropriate filter settings:
  • LFF: 2-20 Hz
  • HFF: 10 kHz
  • Sensitivity: 50 μV/division

Nerve Conduction Studies (NCS)

Sensory NCS Protocol

1. Upper Extremity

   • Median nerve (digit 2 to wrist)
   • Ulnar nerve (digit 5 to wrist)
   • Radial nerve (dorsum hand to forearm)

2. Lower Extremity

   • Sural nerve (calf to lateral malleolus)
   • Superficial peroneal nerve

Motor NCS Protocol

1. Upper Extremity

   • Median nerve (APB)
   • Ulnar nerve (ADM)
   • Musculocutaneous nerve

2. Lower Extremity

   • Peroneal nerve (EDB)
   • Tibial nerve (AH)

Needle EMG Examination

Muscle Selection Guidelines

• Examine at least 3 muscles per myotome
• Include both proximal and distal muscles
• Sample paraspinal muscles when indicated

Recording Parameters

• Insertional activity: 50-100 ms/division
• Spontaneous activity: 100-200 ms/division
• Motor unit analysis: 100 μV/division

Documentation Requirements

Essential Elements

1. Patient demographics
2. Study indication
3. Detailed findings
4. Waveform measurements
5. Clinical interpretation

Quality Assurance

Technical Factors

• Maintain skin temperature >32°C
• Document distance measurements
• Record artifact-free waveforms
• Apply consistent stimulation technique

Safety Protocols

• Use universal precautions
• Proper needle disposal
• Equipment sterilization
• Patient monitoring