Ventriculostomy/ICP question

  1. In our 30 bed combined Trauma/Neuro/Surgical/Cardiovascular/Cardiac ICU, we are having a bit of a dilemma as to where to level the transducer on our ICP drainage set. We use the Codman system. I was taught by my preceptor that it's levelled to the tip of the ear. I've read in several different areas that it should be levelled to the tragus of the ear and another reference said it should be levelled to the outer canthus of the eye. Which is correct? I know that it DOESN'T get leveled to the phlebostatic axis where we level the transducers for our Swans and Art lines yet some RN's in our unit have done that and then called the MD when the readings were off! Thanks for your help!
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    About RNforLongTime, BSN

    Joined: Mar '01; Posts: 2,730; Likes: 604


  3. by   rstewart
    This is a good question......of course I define a good question as one which has puzzled me in the past or present. lol Actually, there is more than one correct answer or I should say there are several different reference points/external landmarks in the literature for proper icp monitoring/transducer leveling.

    I would certainly check your facility's policy and procedure manual first. If the matter is addressed, I would use that. If not, perhaps you and some others might work to write a policy. If you are doing ICP monitoring, you need one.

    What has worked for me is to ask the neurosurgeon at what level he or she desires the transducer. Then I clearly/prominently document the position where the measurements are to be obtained.
    This serves 2 purposes: If the surgeon is a stickler for specific landmarks for different catheter tip positions, you will know it. Secondly, you will achieve consistancy in your readings between nurses which is extremely important yet apparently lacking at present.

    As noted above, if specified I would definitely use the facility's written policy. If you are asked by the surgeon to deviate from that policy, I would write that as an order---in turn the order should be transcribed to the Kardex/computerized patient profile or the like to insure accurate communication between nurses.

    Probably not the concrete answer that you were looking for, but it has worked for me. I do think the generic answer is between the top of the ear and the corner of the eye.
  4. by   RNforLongTime
    Our policy states to level to the external audotory meatus of the ear. So, that's what I've been doing. Now our CNS states that it should be levelled to the tragus. Are they the same thing?
  5. by   redrn99
    In our unit the transducer is leveled at the tragus of the ear, we usually keep the drainage bag (codman)lower to facilitate draining.
  6. by   RNforLongTime
    Well, one of the new neurosurgeons wants us to level a ventric. to the pinna of the ear. Hmmm...wish they'd make up their minds!!!!!!
  7. by   bjpeace
    Hi nurse-lou,
    Our codman rep instructed us to use the tragus.
    Just adding my two cents,
  8. by   RNforLongTime
    Thanks all for your input!
  9. by   New CCU RN
    I know nothing about neuro!!!! But I just wanted to say, what a combo of ICU's.... are you trained in all aspects?
  10. by   passing thru
    Don't they try to make something simple complicated ? Since they came out with the first intracranial/intraventricular monitoring devices and transducers , it has always been the tragus.
    I love neuro ICU. What a challenge ! Keeping the intraventricular pressures within the narrow ranges
    prescribed. Gave lots of IVP meds in that unit !
  11. by   RNonsense
    We run EVD's on the floor. Policy is to the tragus, unless the surgeon specifically orders something else.
  12. by   RNforLongTime
    To answer your question New CCU RN, we get a little of everything in my ICU which I love but is also a PIA as you never get to become an "expert" so to speak. But there's always someone that I can go to with questions. I've figured out which RN is good at what specialty. I've decided that if they ever split the units back up that I want to be in the CV surgery side of things.

    They don't give a new RN in the unit a ventric pt unless that person has previous experience with them or they've been paire with another RN and oriented to Ventriculostomies.
  13. by   New CCU RN

    That makes sense. It also does sound interesting having everything combined. We have six ICU's in my hospital, however, we often get eachother's overflow. I love taking off service patients because there is always room for learning. Being a CCU we take mainly micu patients but also get alot of surgical traumas, and neuro patients. If the patient is too sick ie) needs a ventric then we will do a lateral transfer. Just like if one of our patients was in neuro and they needed a balloon pump.
  14. by   gwenith
    As with CVP, PAWP ETC it does not matter what point you use as a "zero" as long as EVERYONE is using the same point consistantly. I once worked in a unit that zeroed CVP measurements from the sterno-manubrial angle on the basis that it was a more accurate reference when positioning a patient on thier side.

    For ICP we actually used a midpoint between ear and eye as a marker for the ventricles. Then you position your patinet onto the side and watch some of the RN's try to zero from the upper ear!