We’re piloting TetraGraph EMG units in two ORs next month to curb residual paralysis and auto-document TOF in Epic, and I’m trying to lock in a workflow that boosts compliance without slowing turnover. If you’ve used TetraGraph vs TOFscan, what probe placement habits, alert thresholds, or integration tweaks improved signal reliability and changed extubation practice rather than becoming another ignored monitor?
We moved to TetraGraph last quarter and the behavior change came from a hard stop: we don’t extubate unless the display shows ‘TOFr ≥0.95’, and Epic throws a BPA if the last ratio is <0.9 in the prior 5 minutes. For signal reliability, clean/dry skin and ulnar/adductor pollicis placement with the hand outside the Bair Hugger path, plus a quick impedance check before draping — otherwise cautery noise makes it useless, . If you trial TOFscan too, it needs a calibration each case; TetraGraph doesn’t, but it’s fussier about electrode spacing.
Piggybacking on @nash_avery66, what changed behavior for us was adding a soft alert at TOFr 0.92 so we dose reversal earlier and reliably hit “≥0.95” by extubation. With TetraGraph we alcohol-prep and place ulnar/adductor pollicis on the arm opposite the NIBP and warm the hand, then Calibrate before induction — skip that and the EMG is trash, . In Epic we auto-stamp a “reversal given” event and require a TOFr within 5 minutes pre-extubation; TOFscan worked too but needed a preload clamp to be as consistent.
Quick tip that stuck: we wipe with alcohol, let it dry, warm the hand, and route the cable away from the Bovie cord — signal went from flaky to solid on TetraGraph vs TOFscan. Our tiny rule — “baseline before drapes, re‑prep if sweaty” — plus showing the live ratio on the room display in Epic nudged earlier reversal without slowing turnover.
Run TetraGraph impedance check pre-induction and add strain-relief; Epic captures a clean ‘last ratio’ at extubation; face if arms tucked.