ICP monitoring and ventricular drain.

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Would like to hear your thoughts. When do you turn off the clamp closest to the patient? Turns and position changes? To CT? Never unless the surgeon says so?

Thanks in advance!

Specializes in NICU, ICU, PICU, Academia. Has 46 years experience.

In PICU, we clamp the drain anytime we move the patient (up to chair, to CT, etc)

MLB55

83 Posts

In our 23 bed neuro icu, we clamp the drain to transduce pressures, position changes, and when we transport the pt.

nrsang97, BSN, RN

2,602 Posts

Specializes in Neuro ICU and Med Surg. Has 22 years experience.

Same as the pp said. We clamp with positioning, transport to ct, mri, and to get pressure readings.

Specializes in Trauma/Critical Care. Has 10 years experience.

The rationale for clamping a ventriculostomy device (EVD) is to evoid overdraining of CSF, which may lead to brain herniation. If you place the EVD below the patient, you will normally see an increase of CSF drainage, due to gravity. For this reason, most EVD protocols recommend clamping it with any changes in patient's position that may place the EVD below the patient.

RNwannabeCNM

17 Posts

Has 1 years experience.

I also clamp when draining the cylinder, which is how I was taught. I've seen others do it without clamping, but I would think that would cause a pressure differential that could cause over draining.

lotus81

2 Posts

What others said! Also clamping to see if patient can tolerate draining their own CSF otherwise they would fail and get VP shunts.

Esme12, ASN, BSN, RN

4 Articles; 20,908 Posts

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 43 years experience.
I also clamp when draining the cylinder, which is how I was taught. I've seen others do it without clamping, but I would think that would cause a pressure differential that could cause over draining.

it also opens the system/brain to the air increasing an infection risk or air in the ventricles.

ausrnurse

128 Posts

Specializes in ICU. Has 4 years experience.
it also opens the system/brain to the air increasing an infection risk or air in the ventricles.

I wasn't taught this but our system is closed with a sterile bag attached to the bottom of the cylinder. I'm unsure if you are talking about an open system in which you have to open up the system to air to empty the cylinder? I would certainly be clamping towards the patient if that was the case.

Esme12, ASN, BSN, RN

4 Articles; 20,908 Posts

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 43 years experience.
I wasn't taught this but our system is closed with a sterile bag attached to the bottom of the cylinder. I'm unsure if you are talking about an open system in which you have to open up the system to air to empty the cylinder? I would certainly be clamping towards the patient if that was the case.

If you leave it open to the patient while dumping the cylinder to the bag....it can be a problem. That is what our neuro team felt.

When draining it is open to the patient and cylinder closed to the collection bag. When emptying the cylinder you close it to the patient and open it to the drainage bag.

When you are done you close it to the collection bag and open it up to patent/drain/monitor.

ausrnurse

128 Posts

Specializes in ICU. Has 4 years experience.
If you leave it open to the patient while dumping the cylinder to the bag....it can be a problem. That is what our neuro team felt.

When draining it is open to the patient and cylinder closed to the collection bag. When emptying the cylinder you close it to the patient and open it to the drainage bag.

When you are done you close it to the collection bag and open it up to patent/drain/monitor.

Interesting. I checked our protocol and asked around and it definitely isn't the practice at our unit. I guess it is one of those things that depends on the neurosurgeon.

Fumanchuesday

210 Posts

Specializes in Neuro ICU, SICU. Has 3 years experience.

In my unit, we close it when turning or bathing the pt, when we go on trips (CT, MRI, etc), and when we have an order to close it usually followed by a CT the following morning to see if the EVD can be pulled. We also clamp it hourly to measure ICP. We do not clamp it when emptying the chamber.