Quote from TNNURSE
I have a question for all the Neuro ICU nurses.I have heard some of you guys speak of triple h therapy....what is triple h therapy and why is it used?
And the second part of my question is on ICP monitoring.At what reading/range do you get "worried" about your patients?I know any type of prolonged elevated icp can cause injury...but I am talking about being worried over immediate /possible significant sentinel event type of worried?
For the elevated icps what drugs are typicall ordered on your unit...decadron,mannitol,dilantin.....anything else?thanks!
Ok...I answered the triple H therapy question in the thread about needing insight from neuro nurses.
Textbook normal ICP is 0-10. Anything up to 15 is acceptable. Most facilities use the following rule of thumb..."Call for ICP >20 sustained for more than 5 minutes". Now, obviously if my patient's ICP is 19 and they are having changes, then I'm gonna call.
Drugs: Dilantin is an antiseizure medication. Decadron is a steroid used to decrease swelling, but doesn't really do anything for ICP.
Yes, they use Mannitol, but that gets kind of tricky. First of all, you have to monitor serum osmo and sodium (hold parameters are usually Na >150 and Osmo >320). Also, Mannitol is a drug that the more times you use it, the less effective it becomes.
Some other drugs that you may want to look into that can be used are propofol (for sedation) and pentobarb.
Other things that may be done to decrease ICP: lower the gradient on the drainage bag, keep the persons head straight to facilitate drainage (sounds simple, yes, but it helps), bone flap removal.
Just a few things to help you get started on your way...hope it helps!