Leveling art line to tragus for cpp??? - page 4

Hello all. I am taking a class that stated in a sitting/semi-fowlers patient that we have concerns with CPP, we should level the art line at the tragus (or where every you would level your ICP... Read More

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    if pt has an evd we level our A line with the EVD for CPP

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    I am probably a few years late for this thread but I thought I would put my two cents in! i am currently working at a Private Hospital Intensive Care unit which specialises in all specialties in sydney. I have also previously worked in one of the leading neursurgical ICUs in Sydney. At both of my areas of employment we ALWAYS level our arterial lines at the tragus for all our neuro patients. I know that this is also common practice at most other neuro ICUs in Sydney. However, I have not been able to find any evidence or documentation to back this up. It is just what we do and i think the initial orders for this have come from our neuro surgeons. If anyone could tell me where I could find information to back up this practice i would be greatful! I have just because the CNE in my unit and the cluey new staff are wanting to know why we do what we do! Thanks!!
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    I'm a year or two late on this thread, but I found it so interesting....

    I've worked in two ICU's that have had neuro patients and both places have leveled the art at the phlebostatic axis and just wondering if there's be any additional research on this topic that anyone has heard of
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    I dont have any evidence to support the practice of leveling to the tragus but it makes sense. The perfusion pressure of any organ is going to be equal to the MAP minus the highest force opposing the map. In the brain it could be ICP or CVP if that is higher. Most organs perfusion pressure is going to be MAP minus the venous pressure. The point is the closer you can approximate the arterial pressure directly entering the organ of interest the closer you are going to be to the actual perfusion pressure of that organ. The physics just make more sense that way than leveling the art line to the heart and calling it good enough.

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