Leveling art line to tragus for cpp??? - page 3

Hello all. I am taking a class that stated in a sitting/semi-fowlers patient that we have concerns with CPP, we should level the art line at the tragus (or where every you would level your ICP... Read More

  1. by   Starmnm
    We level our art lines to the phlebostatic axis. We level our EVDs to the tragus. I haven't heard of leveling art lines to the tragus before.
  2. by   CCRNDiva
    I'm in a level II trauma center and we level ABP at the tragus when they have an ICP to calculate CPP. I've been there 7 yrs and thats how I was trained to do it.
  3. by   I see you RN
    We're phleb axis people on our NICU. I'll be interested to see what research comes out to support zeroing at the tragus. We also use 3% saline and mannitol; I've never seen a higher concentration of saline ordered. We don't have a standard practice regarding ventrics; we require orders be written for every one. Typically what I see is a pop off around 12 mmH2O and then clamp after a certain amount of drainage for an hour, then open depending on the ICP/CPP. My unit is small and specialized; trauma has their very own floor so our practice might be different because of that.

    ETA that I clamp every hour to get the reading.
  4. by   experienceawareness
    My unit does not transduce art lines at the tragus for cerebral perfusion nor at the kidneys, colon or anything other than the phlebostatic axis. I'm curious to see the evidence based practice or something on this.
  5. by   link51411
    if pt has an evd we level our A line with the EVD for CPP
  6. by   majahindmarsh
    I am probably a few years late for this thread but I thought I would put my two cents in! i am currently working at a Private Hospital Intensive Care unit which specialises in all specialties in sydney. I have also previously worked in one of the leading neursurgical ICUs in Sydney. At both of my areas of employment we ALWAYS level our arterial lines at the tragus for all our neuro patients. I know that this is also common practice at most other neuro ICUs in Sydney. However, I have not been able to find any evidence or documentation to back this up. It is just what we do and i think the initial orders for this have come from our neuro surgeons. If anyone could tell me where I could find information to back up this practice i would be greatful! I have just because the CNE in my unit and the cluey new staff are wanting to know why we do what we do! Thanks!!
  7. by   miss arron
    I'm a year or two late on this thread, but I found it so interesting....

    I've worked in two ICU's that have had neuro patients and both places have leveled the art at the phlebostatic axis and just wondering if there's be any additional research on this topic that anyone has heard of
  8. by   aCRNAhopeful
    I dont have any evidence to support the practice of leveling to the tragus but it makes sense. The perfusion pressure of any organ is going to be equal to the MAP minus the highest force opposing the map. In the brain it could be ICP or CVP if that is higher. Most organs perfusion pressure is going to be MAP minus the venous pressure. The point is the closer you can approximate the arterial pressure directly entering the organ of interest the closer you are going to be to the actual perfusion pressure of that organ. The physics just make more sense that way than leveling the art line to the heart and calling it good enough.