I have a questions about the different policies on zeroeing the fluid filled transducers on EVD's I have worked for 2 different hospitals one in Dallas and One in houston. i have been doing NTICU for 10 years now. Both I have worked in we have worked with Integra's drainage system. Well Hospital policy at both hospitals had us zero and level at EAC the fluid transducer which was zeroed to atmosphere, just as we do the ART lines CVP ect. at the begining of each shift. Our EVD systems are open to drain from 0CM H2O - 20 CM H2O above EAC with hourly clamping to monitor. The only thing is that we have recently had a policy change at the present hospital I work at (the one in Houston) and now we zero completely diferently than before. Zeroing the old way as we do an art line and CVP lines made sense to me. Now the new way, we zero the transducer (which is filled with NS) and it is open to the CSF above the patient where it drips into the buretrol.
My point is that when we zero an art line the for example there is a one way valve that leads to the pressure bag that you have to release and above the transducer there is a threeway stopcock that is turned of to the patient. to zero, hence the transducer is the only thing that is being oepened to air (atmosphere) and being leveled. MEaning tehre is no interferecne from the pressure from the pressure bag becaseu of the oneway valve and no interferece from the patietn because the stopcock is off to the patient. I open the system to air by removing the syringe from the threeway stopcock. Sorry I know this is redundent to explain zeroeing and art line or cvp, but when done correctly and you know you are doing it correctly you can flick the tubing while you are zeroing, if there is no pressure interference by you flicking the tubing then you know you are correctly zeroeing only the transducer to atmosphere at a specified level.
Presently zeroeing the EVD system the new way if you flick the tubing with your finger while zeroing the transducer you get interference on the monitor while zeroeing, ontop of it being open to the csf in the line as well as the saline in the transducer, meaning we zero the transducer with saline and CSF now.
Or am I being to anal and none of this really matters we are just to do what we are told without and rationale.
May 10, '09
I'd be very reluctant to open an EVD transducer to air AND to the patient. 1) You won't be zeroed to the atmosphere because of the pressure in the transducer from the patient side (won't your monitor "tell" you if it detects pulsatile pressure?) and 2) you're exposing the CSF to any number of pathogens that could find their way into the patient's head (and yourself to any number of pathogens that might already be in the patient's head!!). We use the strictest aseptic technique for any manipulation of our EVDs and transducers. They aren't connected to a pressure bag; there's no possibility that way of accidentally infusing fluid under pressure into a person's head. (Imagine the incident reporting on that one!) The transducer and pressure tubing are flushed with sterile, preservative-free saline, clamped and capped until all connections are secured. I think you should speak to both one of your neurosurgeons and your clinical nurse educator and clarify everything.
May 10, '09
Why do you think I am asking this question. Before this new hospital policy the transducer was zereod to atmosphere without being open to the patients csf at all, therefore not leaving the potential for patient getting possible ventriculitis ect... I agree as I said in my post. The way I have been doing it the past ten years the transducer was not open to any csf, now per new hospital policy it is. Before the transducer is only zeroed to atmosphere. And by the way I do not think I implied I had a pressure bag on the EVD system. I don't think you understand what system I am talking about. The evd System we use are Integra's and we place only the transducer by itself on the system not any pressure tubing or anything, we wasted lots of tubing to just get the transducer off which is money, well now they individualy have transducers without the tubing for our purposes, thank goodness because we were wasteing lots of tubing. Anyways we place NS in the transducer and hook this up to the EVD. I have allready spoken with the educator. She told me I am being obsessive and that i will never be able get her to change her mind about how we do things now. The issue about this instance is that two different manufacteres create two different items for this system. Each manufacteres says on there systems refer to the other manufacter for how to use system. I jsut think this is not a good thing for our patient population, It is just a potential for infection waiting to happen. I guess I just care to much.
May 10, '09
You mentioned a pressure bag in a rather confusing description of zeroing art lines, which clouded the issue in my mind. I see what you're saying now.