Question About Ventriculostomies

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Specializes in Intensive Care.

We've been having a debate at work on setting up the ventriculostomy with the external transducer to measure the ICP. We're a small hospital and don't get many ventriculostomies, but we've had several lately. On one we were told not to inflate the pressure bag on the external transducer because with it inflated it gives a continuous flush of approximately 3 cc/hr. I completely took the pressure bag off so that it would not be accidently inflated. The next one we get, we're told to inflate the pressure bag because it won't transduce if it's not inflated. Some say you can do that as long as you roller clamp it off so that they won't get the flush, others say leave it open and it won't flush anything if the pigtail isn't pulled. Also, if you're going to clamp it off what's the point of the pressure bag? I was just wondering what some of you neuro ICU nurses say since you probably deal with these a lot more often than we do. I hope my question makes sense.

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

I'm confused. On what exactly are you putting the pressure bag? I've never hooked a bag of anything to a ventriculostomy.

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Specializes in CEN, CPEN, RN-BC.

Preservative free normal saline solution...

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Specializes in MICU for 4 years, now PICU for 3 years!.

we use a 20cc syringe filled with preservative free NS attached to the top of our transducer

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.
Preservative free normal saline solution...

we use a 20cc syringe filled with preservative free NS attached to the top of our transducer

My question wasn't exactly what fluid to use but onto what they were physically applying a pressure bag. We always did the syringe thing as well. We never attached a bag and even if we did we absolutely would not put a pressure bag on the line.

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.
On one we were told not to inflate the pressure bag on the external transducer because with it inflated it gives a continuous flush of approximately 3 cc/hr. The next one we get, we're told to inflate the pressure bag because it won't transduce if it's not inflated. Some say you can do that as long as you roller clamp it off so that they won't get the flush, others say leave it open and it won't flush anything if the pigtail isn't pulled.

Transducers have a basal rate when a pressure bag or pump is used (in your case 3ml/hour). Whoever told you that the patient isn't getting anything unless the pigtail is pulled is grossly un-educated. The pig-tail allows for a flush after sampling...that is its main function. Think about it. You likely use the same type of transducer on art lines and CVPs. If there was no flow unless the pigtail was pulled then you would have a lot of clotted lines. You might want to check with your nearest tertiary center as well. They may have some excellent nursing education materials available.

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Specializes in Neuro ICU and Med Surg.

I work neuro ICU and we NEVER put a pressure bag on a transducer for an EVD (external ventriculostomy drain) and don't put a syringe on the transducer either. We use the ones made by integra and use a transducer with out a pigtail. NEVER EVER flush one toward the patient ONLY AWAY from the patient.

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Specializes in SICU.

You should not have anything attached to the transducer and defiantly it should not be on a pressure bag. The whole point of putting in a ventric rather than a camino is so the fluid can drain from the head. Instead you are putting fluid into the brain, a high risk source of infection and causing an increase in pressure. As nrsang97 said, your transducers should not have pigtails on them.

If you don't have the correct supplies because you are a small hospital please talk to the doctors about transfer those pt's to a higher level of care, so they can be treated correctly. I am surprised that your neurosurgeons have not corrected this practice before now. Please look up the policy and if you don't have one, then go to your educator about this.

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Specializes in Trauma/Critical Care.
We've been having a debate at work on setting up the ventriculostomy with the external transducer to measure the ICP. We're a small hospital and don't get many ventriculostomies, but we've had several lately. On one we were told not to inflate the pressure bag on the external transducer because with it inflated it gives a continuous flush of approximately 3 cc/hr. I completely took the pressure bag off so that it would not be accidently inflated. The next one we get, we're told to inflate the pressure bag because it won't transduce if it's not inflated. Some say you can do that as long as you roller clamp it off so that they won't get the flush, others say leave it open and it won't flush anything if the pigtail isn't pulled. Also, if you're going to clamp it off what's the point of the pressure bag? I was just wondering what some of you neuro ICU nurses say since you probably deal with these a lot more often than we do. I hope my question makes sense.

If your facility uses the Accudrain made by Integra (most commonly EVD used, out there), you should NOT have a pressure bag attached to it. Attaching a pressure bag to an EVD (external ventriculostomy) is a very dangerous practice (there is a risk of flushing fluid into the brain....now that would be a sentinel incident waiting to happen). I strongly advice you, to get your unit educator on board to create a practice guideline. If you are using an Accudrain, Integra offer FREE education about the product. Your manager/educator needs to contact the company representative.

Good Luck:twocents:

http://www.medcompare.com/details/46988/AccuDrain--External-CSF-Drainage-System.html

http://investor.integra-ls.com/releasedetail.cfm?releaseid=234968

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OMG!!! Pllllleeease tell me you are confusing an ARTERIAL LINE pressure bag transducer system with a ventriculostomy transducer system??! I work in a neurovascular/surgical ICU and a pressure bag should NEVER be NEAR a ventriculostomy. We use the same TUBING for an EVD, it is primed before attaching it to the patient and that's it. No syringe or pressure bag. That's for an arterial line transducer system only. If a ventric ever needs to be flushed, only done so legally per hospital policy by an MD ONLY.

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We've been having a debate at work on setting up the ventriculostomy with the external transducer to measure the ICP. We're a small hospital and don't get many ventriculostomies, but we've had several lately. On one we were told not to inflate the pressure bag on the external transducer because with it inflated it gives a continuous flush of approximately 3 cc/hr. I completely took the pressure bag off so that it would not be accidently inflated. The next one we get, we're told to inflate the pressure bag because it won't transduce if it's not inflated. Some say you can do that as long as you roller clamp it off so that they won't get the flush, others say leave it open and it won't flush anything if the pigtail isn't pulled. Also, if you're going to clamp it off what's the point of the pressure bag? I was just wondering what some of you neuro ICU nurses say since you probably deal with these a lot more often than we do. I hope my question makes sense.

Remember NO HAP - NO HEPARIN, NO ASPIRATION, NO PRESSURE BAG!

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