continuous monitoring with EVD???

There are two issues here; how to position the stop cock on the EVD, and turning patient alarms off. I’ll address the alarm issue first.

I NEVER turn off alarms, particularly to invasive devices. This can be a big safety issue. If the limits are appropriately set then they alert you to changes in your patient’s condition. Leaving the alarms on will also notify you if any of you monitoring devices have become dislodged or disconnected.

I am not sure which system you are using so the following is applicable to the Becker EVD and monitoring system. The 3-way stop cock can be positioned to allow the following:

Off to transducer, open to drain: Only allows for drainage of CSF; does not monitor pressure or display true wave form.

Off to drain, open to transducer: If properly zeroed and leveled will display an accurate ICP and appropriate wave form; does not allow for drainage of CSF.

Open to both drain and transducer: Allows for drainage of CSF and will display ICP and wave form. Due to the fact that the CSF is going to take the path of least resistance and flow into the drip chamber neither the ICP or waveform is going to be accurate. It has been my experience that regardless of what the ICP actually is, the displayed value typically remains 1 – 3. This will allow you to leave the alarms on.

If the patient is ordered to be “open at x” I will leave the stop cock open to both the transducer and drain. When I come in to do my hourly checks, I turn the stop cock off to the drain. This allows me to obtain an accurate ICP and that hours CSF drainage. I also suction, reposition, etc. while I have the drain closed. When done I reposition the drain and open the stop cock to both the transducer and drain.