My bad, I DID assume the child either had a cerebral AVM (ateriovenous malformation) or a subarachnoid hemmorage. To my knowledge, these are the most common bleeds in newborns. In both cases, the blood has the potential to flow into the surrounding spaces and obstruct the normal flow of CSF through the ventricles, thereby causing hydrocephalus.
In the previous post, I forgot to address the nursing duties for caring for these infants.
Assessment would include the following:
Fontanels-assess for tight and/or bulging fontanel (indicates increased icp) or for sunken (dehydration and/or excessive drainage of csf). Preferable, fonatanel will be soft and flat.
Assess respiratory rate, note any increased work of breathing.
Pupilary reaction-should be equal, round and reactive to light. This is one of the key indicators of increased ICP as they may become sluggish in reaction or completely non-reactive and unequal.
Activity level- Is the infant alert, arousable, irritable, lethargic?
Vital signs- The two I use most often are heart rate and temperature. Another good indicator is oxygen saturation.
In the case of increased icp, the infant will become bradycardic in early on as the body attempts to compensate. In the later stages of increased icp, as the body begins to decompensate, the heart rate will drastically increase (above baseline). This fact is true with children, I believe it is different with adults.
If the child has the EVD because of infection, the temperature is a good indicator of sepsis. Low temp will also cause bradycardia, so before determining increased icp d/t bradycardia the temp should be assessed.
Oxygen saturation will also begin to decrease as icp increases, but in my experience this comes after bradycardia.
Monitor strict input and output. Don't forget to account for the csf output. We often replace the amount of csf output with IV fluids if the csf output is high, or if the infant is becoming dehydrated.
Also, monitor and record the color and clarity of the csf (clear, cloudy, yellow, bloodtinged, etc).
Assess the dressing at the exit site. A wet dressing is a source of infection, and the md should be notified.
You can also monitor the mean arterial pressure, but this isn't something we do on the floor and I know very little about it--prmenrs??
You didn't say what setting this infant was in (ICU or floor) nor what type monitoring was available. With some of the newer external systems, you can monitor icp fairly accurately without a manometer. Until recently we had no way to do this on the floor. You also didn't say if this child was on a vent or had any other medical problems, so I'm going on the assumption that this is all the child had.
It's very important with an EVD to keep it level with the patient (normally at ear level) this would mean the zero point on the evd should be level with the patients mid-ear. The physician will also order where he wants the pop-off. Verify that the popoff is at the ordered level. Also, verify the EVD is clamped or unclamped, depending on the physician's order. They are usually unclamped to allow drainage, except just prior to surgery. They will often clamp the EVD several hours before surgery to allow the ventricles to fill, which gives the surgeon a better view. All the systems I've seen also must be clamped while the burrette(the fluid collection chamber) is being emptied, or a vaccum will be created. We also clamp 15-30 mins at a time to allow parents to hold for feedings and bonding. The EVD must be clamped anytime the patient is being transferred or held. Should the evd be left unclamped and the patient is raised above the evd or the evd is dropped below the patient, there is risk of bleeding and/or herniation. So, be very careful not to knock the evd over.
Ummm, I think that's the basics. If this was a NICU baby, prmenrs can give you alot more info than me. I also found you a pretty good website, just click the link below.
on the above, just search for hydrocephalus, bleeds, etc. Wonderful information source!