ICP Transducers - page 3

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... Read More

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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.

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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.
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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??

    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).
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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....

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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.
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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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    It was my first day working with an EVD, and I had to hook it up to the transducer and monitor. Was it ridiculous to think that it might need a pressure bag to generate a waveform on the monitor, as does a CVP, art-line, etc?

    Another RN set this up but did not explain as I was helping with another procedure.

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    we have the fluid chambered EVDs that transduce ICPs and they must be zeroed to the pt. as they work on gravity. Soo everytime the pt. moves or changed position we have to re zero the EVD..also dangerous if you have a stubborn pt. that wants to stand stright up and dump CSF. We also use the codman wires, they dont need to be rezeroed.

    Oh and we never, ever, replace the transducers..that just opens the system...we do change the fluid bag when it gets full and we do draw CSF samples from the pt. and flush the EVD distally.
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    I have a question... I am normally a cardiac nurse but I had the lovely pleasure of getting a pt with an EVD. I'm not really sure which type it was but it is made by medtronic and is by gravity. My question is... If the tubing(not sure correct terminology) proxomial to the pt has blood in it (which was a small amt. And it was a fresh drain) how do you get rid of it? If you turn the stop cock off to the pt and drain and then flush would that do it??? I followed this nurse who said she flushed the line bc it had some blood in the line. I'm just not understanding how in the world she got that blood that was in the tubing right by the insertion site into the drainage bag by "flushing it". Call me stupid... I don't know... I'm just hoping he didn't do what I think he did? I'm hoping to be wrong... Any help would be appreciated.

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