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Discussion

Using saline for ICP system

Had a discussion with a colleague regarding the use of NS preservative free vs regular NS to prime the ICP system. In my colleague's defense, regular NS can be used to prime the system because it is not "entering" the pt's brain since the whole system drains anyway.

Regardless of this thought, I still think the use of NS preservative free is necessary because even though we're not "flushing" anything inside the brain + fluid drainage, you're still hooking up a tubing with preservative materials to an intraventricular catheter.

Thoughts?

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    It probably makes no difference at all, but not using preservative free NS betrays a certain cluelessness as to the stakes when it comes to someones brain.

    I'd add that using D5W to prime makes as much sense as non PF NS. Would this person do that?

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    So there are two reasons why preservative free saline is absolutely important when priming an EVD, flushing the system towards the patient, administering intraventricular drugs (i.e. tpa):

    1) certain preservatives can breakdown the catheter wall (very rare)

    2) many if not most preservatives used for saline or other drugs are usually neurotoxic and can cause damage to the brain. Ever wonder why we use a betadine scrub preop before brain surgery and EVD placement as opposed to CHG scrub? Well, CHG is neurotoxic.

    My hospital is is very well known for Neuro, they have tons of money but not one nurse or even resident has ever heard of using preservative free saline. However, at my previous job, also Neuro ICU and the one before that, trauma ICU- preservative free saline came with the EVD kit.

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    Betadine is not neurotoxic. You wouldn't shower the brain with it but for sterilising the surface of the patients skin and all "sample" ports it is the Neuro-preferred agent.

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