Icp monitoring setup

The hour measurement period is midday to midday, and volumes are measured 4-hourly. The monitor is usually placed in an extra-axial position surface of the brain, e. At the beginning of each shift it is the responsibility of the RN caring for a patient with an ICP monitor to complete the following mandatory safety checks:.

Turn the 3-way tap on the EVD system off to the rest of the system leaving the system open to the transducer only. Press the button twice and the machine will beep once completed. Dressings of the ICP site need to be observed hourly and documented in EMR flowsheets to enable early detection of any leak. Dressings should be changed sterilely as per Neurosurgeon or when soiled. When it is determined that the patient can have the ICP catheter or device removed, this is performed by a member of the Neurosurgery team on the unit.

The procedure is performed in the treatment room, under sterile conditions with appropriate pain relief, distraction and staff assistance. Ensure the site remains dry and no sign of CSF leak is evident. Please clean and return all equipment EVD measuring set, pole and ICP monitoring devices to theatre upon finishing with patient monitoring. Lumbar drains can be indicated for insertion to assist with CSF leaks, evaluate the effect of reduced CSF pressure or as a temporary external shunt.

The Neurosurgical team will document parameters, drainage height or drainage volume. The revision of this nursing guideline was coordinated by Lauren Tunstall with the support of Cockatoo Ward. Updated December The Royal Children's Hospital Melbourne. External ventricular drains and intracranial pressure monitoring. Definition of terms External ventricular drain EVD : A temporary system that allows drainage of cerebral spinal fluid CSF from the ventricles to an external closed system.

Intracranial pressure ICP monitoring: A temporary device allowing measurement and recording of intracranial pressure. Lumbar drainage devices: A temporary device allowing drainage of cerebral spinal fluid CSF from the subarachnoid space to an external closed system. Whilst this is commonly associated with enlargement of the ventricle, in some circumstances the ventricles do not increase in size. Meningitis: An inflammation or infection of the protective membranes and fluid that surround the brain Standard Aseptic Technique: Aims to prevent pathogenic microorganisms in sufficient quantity to cause infection, from being introduced to susceptible sites by hands, surfaces and equipment.

ICP monitoring may be used in patients with: Severe traumatic brain injury Complex hydrocephalus BIH Benign intracranial hypertension Patients who may need an objective 48hours of monitoring of their ICP to help clarify symptoms or the significance of scan findings A lumbar CSF drain may be used for treatment of CSF leak as part of post-operative care, or in some circumstances, if a ventricular drain is contraindicated.

The patient has a scalp infection. A lumbar catheter for drainage and monitoring of CSF is contraindicated in the following patients: The patient with non-communicative hydrocephalus.

In the presence of a mass lesion such as a brain tumour. Patients with Chiari Malformation or tonsillar ectopia. In the presence of infection in the surrounding area which includes the skin, subcutaneous tissue, bone and the epidural space. Other management may include: Urgent surgical decompression of a space occupying lesion e.

Administration of a hyperosmolar agent e. Note- as the cerebral vasoconstriction reduces oxygen delivery to the brain, this should be employed for only short periods of time whilst instituting other measures. Serum sodium maintained at Therapeutic hypothermia although less evidence supporting this. Mandatory Checks Treatment Orders At the beginning of each shift it is the responsibility of the nurse RN caring for a patient with an EVD to complete the following mandatory safety checks: Patient has a valid EVD order set on EMR that includes; height value , height units , reference point e.

Tragus , drainage e. Reportable limits are noted and adhered which is patient specific. EVD drainage point is set at the prescribed level as per Neurosurgeon documentation in postoperative orders. EVD column is oscillating and patent. Head dressing is dry and intact. Documentation It is imperative that the management of the drain is documented hourly. Hourly documentation must include: Drain status e. Drain levelled e. Drain height cmH2O. Hourly output mL. CSF appearance e. Patient position e.

Patient state e. Dressing status e. Dressing intervention. Levelling the EVD system The pressure transducer of the EVD must be maintained at the same horizontal level as the ventricles to ensure reliable interpretation of its value.

Errors in positioning the transducer Too far above the FOM will lead to a falsely low ICP measurement and insufficient drainage of CSF — in this case intracranial hypertension would go undetected and untreated.

Too far below the FOM will lead to a falsely high ICP measurement and excessive drainage of CSF — with subsequent collapsing of the ventricles with perhaps blockage of the system and unnecessary other treatment. B if collection bag needs to be emptied after CSF specimen is taken, also clean the access hub at the base of the bag with Chlorhexidine 0.

Ensure CSF is discarded into pan room macerator. Cover with dry sterile gauze, the key part cap from side access hub usually red cap to be removed and discarded. Disinfect access hub with Chlorhexidine 0. Changing the EVD system set The entire system needs to be changed using sterile technique every 7 days.

If any of the signs of infection are observed fever, redness or exudate at the site , inform the AUM and Neurosurgical team.

A CSF sample may need to be obtained. This can be due to a variety of reasons: a blockage in the system; accidentally clamped EVD; dislodgement from within the ventricles; CSF leak or rising pressure. Excess Drainage If drainage exceeds reportable limits the Neurosurgeon must be contacted as the risk of excessive drainage can lead to collapsed ventricles, subdural haemorrhage or in some cases upward herniation.

This can be prevented in some instances by intermittently clamping the EVD if the patient has a transient increase in ICP e. Consider a pressure bandage. The Neurosurgery team must be contacted immediately to review the patient and implement the appropriate management. The procedure is completed in the treatment room, under sterile conditions with appropriate pain relief, distraction and staff assistance. Post removal of the EVD, ensure the patient and wound site are observed and the dressing remains dry and intact.

Mandatory checks treatment orders At the beginning of each shift it is the responsibility of the RN caring for a patient with an ICP monitor to complete the following mandatory safety checks: Ensure the patient has a completed valid and correct treatment order on EMR. Ensure the head dressing is dry and intact. Ensure reportable limits are set on monitor and adhered to. Report any signs of changes in patient condition to the medical team.

For an ICP monitor, the reading is taken directly from the ICP monitor this should also correlate with the bedside Phillips monitor- if not, you may need to enter the 3-digit reference code on the ICP transducer. Turn monitor on and ensure appropriate ICP cords and transducer box are available Image coming soon 2.

Set appropriate alarm limits including ICP limits Image coming soon 4. Load paper for printing of ICP, located at the right-hand side of the monitor Image coming soon 5. Codman Monitor 1. Image coming soon 2. Check alarm is turned on via main menu Image coming soon Wash your hands and ensure a non-touch technique Image coming soon 3. Turn the 3-way tap on the EVD system off to the rest of the system leaving the system open to the transducer only Image coming soon 4.

Remove a cap white or yellow to open the transducer to the atmosphere Image coming soon 5. Conduct a preprocedure verification process to make sure that all relevant documentation, related information, and equipment are available and correctly identified to the patient identifiers. Notify the doctor of any unexpected results. Wear appropriate personal protective equipment. Intraventricular Catheter Monitoring In this procedure, which monitors ICP directly, the doctor inserts a small polyethylene or silicone rubber catheter into the lateral ventricle through a burr hole.

Although this method measures ICP most accurately, it carries the greatest risk of infection. This is the only type of ICP monitoring that allows evaluation of brain compliance and drainage of significant amounts of cerebrospinal fluid CSF. Contraindications usually include stenotic cerebral ventricles, cerebral aneurysms in the path of catheter placement, and suspected vascular lesions.

Placing the bolt is easier than placing an intraventricular catheter, especially if a computed tomography scan reveals that the cerebrum has shifted or the ventricles have collapsed. For epidural monitoring, a fiber-optic sensor is inserted into the epidural space through a burr hole. For subdural monitoring, a fiber-optic transducer-tipped catheter is tunneled through a burr hole, and its tip is placed on brain tissue under the dura mater.

The main drawback to this method is its inability to drain CSF. Intraparenchymal monitoring may be used to obtain ICP measurements in patients with compressed or dislocated ventricles. Place the patient in the supine position, and elevate the head of the bed 30 degrees or as ordered. Clip his hair at the insertion site, as indicated by the doctor, to decrease the risk of infection.

Carefully fold and remove the linen-saver pads to avoid spilling loose hair onto the bed. Drape the patient with sterile drapes. Verify that the insertion site has been identified before preparing the site. Doing so will minimize the risk of preparing the wrong area. The doctor puts on the sterile gown, mask, and sterile gloves.

Make sure a time-out is conducted immediately before the doctor starts the procedure to identify the correct patient, site, positioning, and procedure and to ensure that all relevant information and necessary equipment is available.

Reassure the conscious patient to help ease his anxiety. Talk to him frequently to assess his level of consciousness LOC and detect signs of deterioration. Watch for cardiac arrhythmias and abnormal respiratory patterns. After insertion, remove and discard your gloves. Perform hand hygiene, 3 , 4 , 5 put on sterile gloves, clean around the insertion site with antiseptic solution, and apply a sterile dressing to the site.

Intracranial Pressure Monitoring.