ICP Transducers - page 2

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... Read More

  1. Visit  joanna1975 profile page
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    Quote from tnnurse
    [font=lucida sans unicode]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!!!!
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  3. Visit  RoxanRN profile page
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    Quote from 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.
  4. Visit  Keysnurse2008 profile page
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    Quote from 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.
  5. Visit  gwenith profile page
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    Just interested TNNURSE - do you take CSF specimens from your drainage system?
  6. Visit  Keysnurse2008 profile page
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    Quote from gwenith
    just interested tnnurse - do you take csf specimens from your drainage system?
    [font="garamond"]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....
  7. Visit  monkeyman1000 profile page
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    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)
  8. Visit  gwenith profile page
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    Quote from 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??
  9. Visit  RoxanRN profile page
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    We (RNs) routinely draw from the access port nearest the patient (which tends to lend the most accurate sample) as well as flush (toward the drain only!) PRN. It is all done using as sterile/aseptic a technique as possible. Any patient with a ventriculostomy or bolt in place is on antibiotics for the duration of the placement.
  10. Visit  auzzieneuronurse profile page
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    In my unit nurses routinely take CSF specs from EVD's three times a week - we use an aseptic technique and take a fresh sample from the port below the burette. We used to take it from the port closest to the patient but this has now been removed to decrease infection rates and it was deemed that nurses should not be aspirating CSF from the ventricles.

    Our EVD's are only ever changed in theatre.
  11. Visit  Keysnurse2008 profile page
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    Quote from gwenith
    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??
    [FONT="Garamond"]

    Changed my fonts for ya! I completly agree Gwenith.I think it is downright dangerous to access that EVD period.Only the Neurosurgeons or their PA's obtain csf samples, not the nurses. We just feel that it the safest thing for the patient.The fewer times we access the EVD the lowered risk of meningitis/infection. It sounds like you might have seen a I&D of a brain or two also. It isnt pretty when infection sets in,...and they have a cerebral abcess,..and then they have to have a irrigation and debridement of brain tissue.This is not pretty......
    In the Neuro ICU's I work at,we set up for the evds', take care of swans, vents, external pacers, internal pacing wires, balloon pumps,....lots of specialty nsg skills....but.....we dont access the EVD's....it is just the safest thing we feel.And yes...we...(aka the nurses) agree.We just feel the fewer hands accessing an evd the better the potential outcome for the patient.We have a low low low infection rate( next to nil).
  12. Visit  icuedu profile page
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    Ok I have been trying to get this question answered and this thread seemed closest....

    We are having a debate in our unit right now on the "correct" way to zero the transducer on an External Drainage System (Codman EDS-3 to be exact).....

    We have two schools of thought here......One school is that when zeroing out the transducers, the "cap" on the "not attached to anything" end of the transducer needs to be opened to air while the stopcock itself is "closed" to the transducer (Pt's brain -> drain).....Then zero..

    The other school is that the "cap" should never be removed from the stopcock and the system Zeroed while not being open to atmospheric pressure.....

    So I guess my question is......

    How are people truely zeroing the transducers if they are not opening them to atmospheric pressure? (like CVPs, Art lines, etc)......

    We have no policy on "zeroing" the system....

    And yea....we dont change out transducers, blah blah blah

    My question simply revolves around the technique of zeroing....

    Thanks
  13. Visit  auzzieneuronurse profile page
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    Not sure how you can zero the system to atmospheric pressure if you don't remove the cap?? We zero the system once a shift in a completely sterile procedure and change the cap at the same time.
  14. Visit  gwenith profile page
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    It goes back to my answer that there are two distinct types of monitoring system in Neuro. One uses fibre-optic cable, which since it is NOT a fluid filled device, does not need opening to atmosphere to zero - the other relies on pressure waves transmitted through fluid and does need opening to atmosphere to zero.


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