External ventric drains dressing

[chiodecanada]

Hello everybody!!!

I need help. I work at the Neuro ICU and we're having problems with the evd's dressing.

The neurosurgeons want to change the dressings when necessary but when we called them they never want to come. We're trying to establish guidelines for the evd dressing and presented to the neurosurgeons. can anybody send me policies or guidelines that you have at work to help me with my research.............please!!!!

Thank you

[MQ Edna]

I work in a neuro ICU and as far as I know we do not have written protocols regarding changing of ventric dressings. Basically if the dressing becomes old or loose (which often happens because patients heads tend to sweat) the nurse will replace the dressing with a fresh tegaderm (opsite) or a 2 x 2 secured with an opsite (needs to be an occlusive dressing in other words). If there is oozing or leakage at the ventic site at the scalp the physician is notified.

The only written protocols I know about regarding ventrics has to do with intrathecal injections and/or flushing of the line which is only to be done by a physician.

Sounds like your facility does not allow the nurses to change the ventric dressings? I can understand how that could be a pain/bother. Sometimes we have trouble getting the neurosurgeons to come up and remove a non-patent ventric that is no longer functioning. I recently had a patient whose ventric didn't drain or have an ICP waveform for 2 days before someone finally came up to remove it!

[rjflyn, ASN, RN]

I worked at major university hospital in the PICU unit and we as nurses were absolutely not allowed to do anything with a dressing on a ventric. If it were to some how become displaced or fall off we were to place a sterile 4x4 ie just dump one out of a package over the site and call a/the doctor on call for the neuro service.

Rj

PS it would be the residents hind end if he or she didn't respond to a nurses call. Our peds neuro attendings were very demanding, I would not hesitate to travel from anywhere in the country to have them take care of my child.

[chiodecanada]

In our ICU, the nurses are not allowed to touch the EVD dressing but sometimes they are so soiled or loose that we end up changing the dressing. It's just very inconvinient to beg the neurosurgeon or the resident to change the dressing, to beg for a technical procedure that the nurse is able to perform. Hope to get more answers from other nurses.

Just one more question, when the hair stars to grow again and the dressing becomes loose, do you clip the hair again or just apply another new dressing????

Thank you again for all your answers

[MQ Edna]

When the hair starts to grow back we just do our best to secure the dressing or apply a new one if need be. Heaven forbid using scissors around the ventric catheter and cutting or nicking it by accident!