[Aquarian]

I think that you are ALL CORRECT!

The post above is referring to management of Chronic SDH where elevation of ICP is unusual post-operatively, thus pxs are generally maintained supine with minimal elevation of the head for at least 24 hrs to allow some re-expansion of the brain. No external ventricular drainage (ventriculostomy) maintainance for relieving inc. ICP and for ICP measurement.

While the original post and the others following it were referring to post-surgical management of Acute SDH such as those resulting from trauma where ICP is continiously monitored and relieved via venticulostomy (among other modalities of tx). Irrigation is done to clear debris or fibrin deposits from the ICP catheter to allow better waveform transmission and drainage of CSF. But this is often considered an advance practice procedure. Therefore, only physicians, or ARNPs and PAs under a neurosurgeon's guidance may irrigate/instill a solution into the ventriculostomy. Only after proper instruction and with physician's order should an RN does it ( depends on your hospital's policy and procedure manual). The one who irrigates must be familiar with ICP dynamics and the potential adverse outcome from both non-functioning ventriculostomy and irrigation of the catheter.

Procedure:1. Obtain MD order to irrigate with PFNS (preservative-free normal saline).
2. Draw up ordered amount of the solution.
3. Apply mask and sterile gloves.
4. Cleanse the injection port closest to the insertion site of the ventriculostomy drainage system for a full minute w/ betadine and air-dry.
5. Clamp ventriculostomy drain with the clamp attached to the set-up.
6. Make sure the system is free of air bubbles.
7. Inject the solution gently.
8. Do not aspirate to avoid pulling brain tissue into the catheter.
9. Reopen drain per MD order.
10. Observe drain and waveform.
11. Notify MD if the amount of irrigant or drainage does not return to normal.
12. Document procedure, date, time, type and amount of irrigation, waveform pre- and post-procedure and the pressure recordings.

[Creamsoda]

In our hospital, RN's NEVER irrigate the drain. We can irrigate the tubing if needed, as long as the drain is off to the patient. We have been taught that flushing it towards the patient is something nuerosurgery, or the attending does.

Cher

[RNKittyKat]

Per policy, when I was an ICU nurse, we never irrigated without a real good reason. Some of the new drains have one way stop cocks... only out, nothing in.

[Tess597]

Heard of irrigating but usually it is the doc's responsibility r/t liability.