Urgent: In over my head...ICP Monitoring

  1. I chose the topic of external intracranial monitoring and drainage devices as a teaching topic for my PN teaching project. I'm way over my head. I've spent hours trying to understand the nurses responsibility and how and why she levels, zero's out, .....I'm in over my head. I need this in Dummies terms. I am writing a 5 page paper and am to give a 10 minute presentation....Please have mercy and help me...BTW...icufaqs.com: icp monitoring was over my head too.
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  2. 16 Comments

  3. by   Esme12
    Yeah....you probably are in over your head. ((HUGS))

    ICP monitoring is a way to measure how much swelling is present. The brain is contained in a tight container with little room for swelling. The brain when it is injured in some way, like anything else, it swells...but it has no where to go. This causes pressure to build up in the brain causing a decrease in blood flow (cutting off of the blood supply) and damage to the brain itself. If the swelling and pressure is not relieved it will take the only pathway out...downward onto the brain stem (herniation) causing brain death and sessation of blood flow to the brain. Like that little girl Jahi McNath suffered.

    Now...they are meds that can be given as a stop a stop measure and ways to help give a little more space to try to prevent this from happening. BUT...you need to monitor the pressure inside of the brain. This is called the ICP bolt/catheter and/or ventriculostomy (brain drain).
    There are three ways to monitor pressure in the skull (intracranial pressure):

    • A thin, flexible tube threaded into one of the two cavities, called lateral ventricles, of the brain (intraventricular catheter)
    • A screw or bolt placed just through the skull in the space between the arachnoid membrane and cerebral cortex (subarachnoid screw or bolt)
    • A sensor placed into the epidural space beneath the skull (epidural sensor)
    Intracranial Pressure Monitoring | Medical Tests | UCSF Medical Center

  4. by   Esme12
    Now the ventirculostomy drains excess CSF (cerebral spinal fluid) or drains CSF from the fluid filled ventricles of the brain to give more room for swelling by emptying fluid from the ventricles.

    Now this is a gravity type device. If it is too high not enough fluid will leave brain. If it is too low... too much will drain out and possibly collapse the ventricles causing herniation (bulge through) the hole in the bottom of your skull. This normally leads to death.

    So you make sure the device is equal/level with where the ventricles are in the brain. Just like the CVP need to be at the level of the Right atrium of the heart to be accurate....this needs to be level with the ventricles of the brain to be accurate.

    The MD will write the order as to what "pressure" that he wants the CSF to be drained so that when the brain reaches that pressure...it drains. The actual "zeroing" of the ICP is for the monitor so that you get an accurate reading. It is a calibration of the machine to atmospheric pressure and the level of the ventricles to get an accurate reading. (very simply put).

    This may help....http://www.med.umich.edu/1libr/neuro...HeadDrains.pdf
  5. by   Esme12
    Now what else do you need? Ventriculostomy
  6. by   shantel1621
    Thanks Esme12...you just gave me a refresher. I love it when we can help each other, it's a shame that we spend so much time on this site criticizing each other instead of sharing our knowledge.
  7. by   melissamauzey
    Esme12,

    Thank you so much for your input, you are an ICU god. My motivation to use this as a teaching project was that a few months ago, my aunt had a subarachnoid hemorrhage. Following several procedures, they installed and ICP monitor with evd. The ICU nurse was awesome, but naturally very busy, so my curiosity and questions did not get answered. I chose this project as a way to learn about it.

    Could you tell me more about what the nurse does during her hourly checks with a patient like this....Thank you.
  8. by   Esme12
    Quote from shantel1621
    Thanks Esme12...you just gave me a refresher. I love it when we can help each other, it's a shame that we spend so much time on this site criticizing each other instead of sharing our knowledge.
    I am always happy to answer clinical questions...start a thread I'll be there.
  9. by   Esme12
    Quote from melissamauzey
    Esme12,

    Thank you so much for your input, you are an ICU god. My motivation to use this as a teaching project was that a few months ago, my aunt had a subarachnoid hemorrhage. Following several procedures, they installed and ICP monitor with evd. The ICU nurse was awesome, but naturally very busy, so my curiosity and questions did not get answered. I chose this project as a way to learn about it.

    Could you tell me more about what the nurse does during her hourly checks with a patient like this....Thank you.
    I am sorry your Aunt was ill...((HUGS)) How did your Aunt do?

    IN the presence of SAH there is blood blocking the ventricles. It clots the space, causes hyrocephalus, and an elevated ICP.

    The nurse is checking every hour for output and positioning. They are usually given parameters for increasing ICP or a change in drainage by the MD. Because this can be such a critical invasive device it is checked hourly for drainage and ICP readings. The nurse will then adjust the EVD (external ventricular drain) for optimal results.

    An example of orders for the EVD .....http://www.mghneuroicu.org/pdf/SAH%2...ement_2010.pdf
  10. by   Esme12
  11. by   melissamauzey
    Esme12,

    Thanks so much for your help. My aunt is trying to rehabilitate from the damage the SAH did. She has had the flap repaired and has spent time in a rehab facility. She still has a tracheotomy but I think she's just about ready to have it removed. She is aware of her surroundings but cannot speak clearly, she wants to write, but cannot put thoughts into words. She has many issues. She has little use of her left side. Brain injury is so difficult for families. We try to stay positive and stay involved with therapy as much as possible.
  12. by   Esme12
    Quote from melissamauzey
    Esme12,

    Thanks so much for your help. My aunt is trying to rehabilitate from the damage the SAH did. She has had the flap repaired and has spent time in a rehab facility. She still has a tracheotomy but I think she's just about ready to have it removed. She is aware of her surroundings but cannot speak clearly, she wants to write, but cannot put thoughts into words. She has many issues. She has little use of her left side. Brain injury is so difficult for families. We try to stay positive and stay involved with therapy as much as possible.
    ((HUGS)) I'm sending prayers for your Aunt.
  13. by   lotus81
    I work on a Neuro-ICU floor. We deal a lot with ICP and Ventrics. Our responsibilities with Ventrics include: assess the patency of the device, leveling to whatever the neurosurgeon has ordered, assess the amount and color of CSF, and patient's tolerance. As for ICPs, -monitor trend and intervene (sedation and pain-management, pressors, 3% NACL, mannitols, and temp regulation). And make sure those devices don't get pulled out!!!
  14. by   alwayslearning5
    Thanks so much Esme!! I am a new grad nurse who just today scheduled an interview for tomorrow morning in the Neuro ICU at the hospital I'm a tech at. I wanted to review some neuro specific critical care content while sitting tonight but my notes/books are at home. This was perfect!!! So incredibly helpful.

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