ICP monitoring and ventricular drain.

[sugarmagnolia3]

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!

[TBWIRN]

We also clamp whenever suctioning a patient.

[mahmudghesmati]

we clamp too, as everyone

[NurseNancy888]

Regarding neurological status: level of conciousness (Glasgow Scale), comatose, on mechanical ventilation, failed SBTs, or seizures; If ICPs WNL

[RN-SKR]

Yes, We also clamp it when doing anything that would change the position or level of the drain so we don't drain to much. In my hospital we don't need an order for it, it's common nursing practice in our neuro ICU.

[Delia37, MSN]

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!

The EVD set that we use at my facility (Integra) comes with two ports/clamps. One close to the patient head (sample port) and the other in the transducer (which should be leveled at the tragus). The clamp at the transducer should be the one clamped for repositioning/zeroing, since it will give you a continuous ICP reading. The clamp closest to the patient is only used for sampling, flushing, or instilling medication (i.e.. Tpa). At my facility, nurses are allowed to flush AWAY from the patient, using the port/clamp closest to the head (check your facility policy); only the NSG surgeon is allowed to sample CSF sample from this port. Other than that, that clamp should never be clamped (if you are using the Integra set up).

[Delia37, MSN]

Regarding neurological status: level of conciousness (Glasgow Scale), comatose, on mechanical ventilation, failed SBTs, or seizures; If ICPs WNL

Removal criteria mainly depend on how much CSF in being drained and if there is still blood in it (if it is a SAH). The MD will order the level where she/he wants the buretrol (0-20; sometimes negative numbers); once discontinuation is being considered, the buretrol will be raise from baseline. At 20, the pt should be having minimal output. For instance, if your order is EVD open at 20 cm H2O and you are having large output (>10cc), the patient is at risk of developing hydrocephalus. The NSG MD sometimes would clamp the EVD for 24hrs and follow up with a head CT. If no changes in neuro status, increase ICPs, or hydrocephalus in CT, they will d/c it; however, in the presence of neuro changes/increase ICP's a VP shunt would be an alternative.