Icp

Front 1

Patient Indications for continuous ICP monitoring (6)

Back 1

1. At risk for secondary injury associated with severe TBI
2. Brain injured patient with Glascow Coma score less than 8
3. Allow for calculation of Cerebral Perfusion Pressure
4. Assess cerebral compliance and auto-regulation
5. Treatment modality by drainage of cerebral spinal fluid
6. Monitor brain tissue oxygen demands-assist treatment of brain oxygen supply and demand

Front 2

Psychological, cultural or age specific interventions for IC monitoring (5)

Back 2

1. Social Service Consults
2. Use translators for language barriers
3. Provide simple accurate explanations for equipment
4. Allow for open visitation
5. Encourage family participation with care

Front 3

Safety Precautions for ICP monitoring (7)

Back 3

1. Maintain sterility with insertion
2. Continuous display if IC waveform
3. Alarms on and audible
4. Neuro check per guidelines and at each handoff
5. Patient identification with all procedures and medications
6. Bed controls locked if EVD is open to continuous drainage
7. Hand hygiene

Front 4

Where is ICP equipment

Back 4

Supply pyxis or ICP insertion kit

Front 5

Equipment needed for insertion of intra-ventricular catheter and EVD (14)

Back 5

1. Cranial access kit
2. Local anesthetic (lidocaine 1% or 2%) in cranial access kit
3. Clippers
4. Betadine, Duraprep, Chlorhexidine to prepare insertion site
5. Ventricular Catheter with External Drainage System
6. Preservative-free (non-bacteriostatic) 9% saline
7. Transducer (with flush tubing removed)
8. Transducer cable
9. Sterile gloves for surgeon
10. Sterile gown for surgeon
11. Masks for people in room
12. Half sheet sterile field
13. Sterile Towels
14. Designated IV pole for EVD and transducer

Front 6

Why preservative free NS?

Back 6

Preservatives are neurotoxic

Front 7

When is EVD changed?

Back 7

Not routinely changed-only if clotted or contaminated

Front 8

Where is ICP zeroed

Back 8

1. Foramen of Monroe-level ensures accurate readings
2. Can't measure pressure when open to drain

Front 9

How to obtain CSF sample (7)

Back 9

1. Hand hygiene
2. Clean port closet to patient with Betadine for one minute and allow to dry
3. Turn stopcock off to patient
4. Withdraw 1ml slowly with 10ml syringe
5. Frank blood - notify MD
6. Place in sterile container with labels
7. Document procedure

Front 10

How to irrigate ICP catheter

Back 10

1. Obtain MD order
2. 3ml sterile syringe
3. Preservative free NS
4. Betadine swab
5. Mask and sterile gloves
6. Clean port closest to patient with Betadine for one minute-allow to dry
7. turn stopcock off to monitor open to the patient
8. Sterile technique-draw up preservative free NS
9. Use 3ml syringe slowly inject into port nearest to patient 1ml saline over 1 full second
10. After irrigation turn stopcock to monitoring position and document post irrigation waveform and ICP value

Front 11

Camino zeroing

Back 11

1. Zero Camino to monitor
2. MD zeroes catheter to patient
3.

Front 12

Goals for ICP monitoring

Back 12

1. ICP < 20
2. CPP > 65
3. PbtO2 > 20mmHg
4. EtCO2 35-40