[TNNURSE]

Originally Posted by Treb4K

I am curious about nursing practice of other NeuroICUs regarding ICP transducer changes. I work in a 20-bed NeuroICU with a large SAH population. Most of these patients' EVD stay in place for more than a week. Our unit policy is to change the transducer every 4 days, using aseptic technique. It is also our policy to use aseptic technique when initially setting up the EVD system, including the attachment of the transducer to the monitoring port of the EVD system. Subsequent changes of the transducer, seem to be breaking the integrity of the system and could potentially contaminate it. We are thinking of changing this policy. Inputs are highly appreciated. Thanks!

We do not ever break that closed system.By changing transducers you have 1.Broken that closed sterile system 2.Increased your patients chances of getting bacterial meningitis by about 50K times. 3. Why...would your neurosurgeons ok such a technique?ESP...aseptic....I mean....that can be quite lethal .
To answer your question...never...we never change that transducer.If the patient cant shunt that excess CSF himself...we take them to the OR and place a VP or a VA shunt in.If...IF....that drain is in for over 10 dAys....the neurosurgeon will under STERILE TECHNIQUE..replace the entire system- ventric cath and all...just like the surgical STERILE procedure he initially did when he inserted it.......but to break that closed system....no way!!!Patient safety...always think patient safety!!!!!

[joanna1975]

Our practice is much the same as RoxanRN2003. We also zero ICP transducers as well as A lines and CVPs at the beginning of each shift. The bolts occassionally get inserted by the Registrar aseptically in the ITU but more often than not they get inserted and changed (if need be) in theatre.

[TNNURSE]

Originally Posted by joanna1975

Our practice is much the same as RoxanRN2003. We also zero ICP transducers as well as A lines and CVPs at the beginning of each shift. The bolts occassionally get inserted by the Registrar aseptically in the ITU but more often than not they get inserted and changed (if need be) in theatre.

Sure we zero the alines ,cvps, and ICPs during the shift.But we dont ever break that closed system to change out a transducer.The EVD's are placed under sterile technique at the bedside....and if in for over 10 days the neurosurgeon will replace the entire system( cath and all) under sterile technique at the bedside.BUt..at the Neuro ICU's I have worked at we feel that breaking that closed sterile system by changing out that transducer is a risk we arent prepared to take. First of all bc the patient is critical or they wouldnt have that drain stuck in their vents to begin with...and secondly bc we dont want to possible introduce bacteria or contaminants into that sterile line.I am sure diff hospitals have diff policies re: this....but I am curious as to what the rationale your hospital and neurosurgeons have re: changing these transducers under aseptic technique?Why are they having you guys do that?Just curious...

[joanna1975]

Originally Posted by TNNURSE

re: this....but I am curious as to what the rationale your hospital and neurosurgeons have re: changing these transducers under aseptic technique?Why are they having you guys do that?Just curious...

They seem to change the ICP bolts if they have been in for longer than a week because they found the reading/trace becomes unreliable/inaccurate. However we seldom have to do this as it is rare for the bolts to remain in for much longer in our unit. In the last year the longest I have seen a bolt in for was 9 days. As to the rationale I will endeavour to find the party line and get back to you!!!!

[RoxanRN2003]

Originally Posted by joanna1975

They seem to change the ICP bolts if they have been in for longer than a week because they found the reading/trace becomes unreliable/inaccurate. However we seldom have to do this as it is rare for the bolts to remain in for much longer in our unit. In the last year the longest I have seen a bolt in for was 9 days. As to the rationale I will endeavour to find the party line and get back to you!!!!

In my unit, it is not uncommon to have a patient with an infected VPS (subsequently removed) and have an EVD in place for the 2 weeks while the infection clears. But on average for all the other EVD patients, I think we range from 7-12 days. The neuro intensivist and/or neurosurgeons have never changed an EVD because of length of time in place. Not to mention, all patients with EVDs are on Ancef for the duration.

[TNNURSE]

Originally Posted by joanna1975

They seem to change the ICP bolts if they have been in for longer than a week because they found the reading/trace becomes unreliable/inaccurate. However we seldom have to do this as it is rare for the bolts to remain in for much longer in our unit. In the last year the longest I have seen a bolt in for was 9 days. As to the rationale I will endeavour to find the party line and get back to you!!!!

I can understand that after a week their are decisions that need to be made.If ...after a week...that patient isnt able to effectively shunt the CSF...under STERILE conditions...the Neurosurgeons change the entire system and ventric cath (only happens on rare occasion).
The reason it happens only rarely is bc the neurosurgeons usually place a VP or VA shunt....bc....why expose the patient again to the risks.After 10 days if they havent been able to shunt off their own CSF adequately...they usually wont...so they just do the VP/VA shunt.I mean any invasive line is a risk for infection.But....guys....we are talking about a cath lying where??????????In the brain...if you have ever worked in a Neuro ICU...or a trauma unit...or the SICU/MICU long term....we all know that a Brain Abcess is not...not ....not a pretty thing to have.When they have to do an I&D of the brain the outcome is poor...so if we can prevent that infection in the 1st place by NOT ACCESSING that EVD...or changing the transducer.But by using ASEPTIC TECHNIQUE.....no no no no no no.....it can be quite lethal.

[gwenith]

Just interested TNNURSE - do you take CSF specimens from your drainage system?

[TNNURSE]

Originally Posted by gwenith

Just interested TNNURSE - do you take CSF specimens from your drainage system?

No...we dont.(the Nurses I mean). All CSF samples obtained for cultures, to test for glucose/protein etc etc is done by the Neurosurgeon only.They are the only ones that break or access that system period. The rationale is ....the more times the closed system is accessed the chances of bacterial meningitis etc increase dramatically.This has been the case in both large Neuro ICU's where I have worked. As i have said....and I&D isnt "pretty" when we are talking about cerebral tissue. What is your policy? I am just kinda in shock that "ANY" HCF would allow a closed sterile system into the cranial vault to be accessed esp under aseptic technique...not even under sterile technique.Hmm....

[monkeyman1000]

Just curious (read: ignorant), why is Ancef always used. I just looked it up in my drug book but nothing specific noted about meningitis or anything. Does this med cross the blood brain barrier better than other antibiotics? Enlighten me O' sage ones, your humble student awaits. (seriously)

[gwenith]

Originally Posted by TNNURSE

No...we dont.(the Nurses I mean). All CSF samples obtained for cultures, to test for glucose/protein etc etc is done by the Neurosurgeon only.They are the only ones that break or access that system period. The rationale is ....the more times the closed system is accessed the chances of bacterial meningitis etc increase dramatically.This has been the case in both large Neuro ICU's where I have worked. As i have said....and I&D isnt "pretty" when we are talking about cerebral tissue. What is your policy? I am just kinda in shock that "ANY" HCF would allow a closed sterile system into the cranial vault to be accessed esp under aseptic technique...not even under sterile technique.Hmm....

First - can I make a suggestion - please make your fonts bigger - don't wear my contacts at home and the way your type comes out I either have to squint at the screen or fiddle around changing the view size.

But about accessing - yes they did access the system but not at the transducer - at the drain end. Still worried the @#$# out of me though. But then, that was not the only thing about that hospital and it's policies that I personally questioned. Ever felt like a lone voice in a wilderness??