ventrics...

[beausud]

hey all, got a pt. here w/ a ventric after a burr hole evac of sdh. md orders were "open drain at -10 cm below ear level" no other parameters were given... we dont get those often here. no call back as of yet from neuro surgeon. what's the "norm" drainage for this type of proceedure... 5-10cc/hr?

*PS: we level the ventric from the base then we adjust drainage from the adjustable burette... right? thx for your time.

[beausud]

well got the call back.. md just said it was just a plain 'ol drain ...to drain excess blood. can anyone else still answer my questions though. thx.

[NotReady4PrimeTime, RN]

Hmmm. -10 cm below the ear is going to have a gravity influence. Drainage could be significant. In our unit the typical order would be "Maintain EVD at 10 (sometimes 15 or 20, depending on mechanism of injury) cm above tragus. If ICP >20 for >5 minutes open drain for 5 minutes. If opening more than 2X/hour call neurosurgery." Other times the order would read to drain continuously at 10 (or 15 or 20) cm above the tragus. We use a laser level to ensure accurate leveling. 10-20 ml of CSF drainage would be normal per opening if the patient has raised ICP; I've seen upwards of 50 ml per hour and been told it's fine, not to worry about it. With your patient and it being for bleeding, I'd be alarmed if I was seeing more than 10 or 15 ml per hour, but it will depend on your neurosurgeon's comfort zone.

[beausud]

Hmmm. -10 cm below the ear is going to have a gravity influence. Drainage could be significant. In our unit the typical order would be "Maintain EVD at 10 (sometimes 15 or 20, depending on mechanism of injury) cm above tragus. If ICP >20 for >5 minutes open drain for 5 minutes. If opening more than 2X/hour call neurosurgery." Other times the order would read to drain continuously at 10 (or 15 or 20) cm above the tragus. We use a laser level to ensure accurate leveling. 10-20 ml of CSF drainage would be normal per opening if the patient has raised ICP; I've seen upwards of 50 ml per hour and been told it's fine, not to worry about it. With your patient and it being for bleeding, I'd be alarmed if I was seeing more than 10 or 15 ml per hour, but it will depend on your neurosurgeon's comfort zone.

hey, thx for your input. the new md order for tonight was to put the drain @ -5 cm below th ear... the MD said that this was just to drain excess blood. there was no parameter to drain a certain amount per hour. i wonder why the doc used this type of drain as opposed to say a JP; there 's no order to closely monitor/record blood drianage... drainage looks sero-sanguinous. thx again for your input.