Monitoring
Device Advantages Disadvantages Nursing Considerations Intraventricular
catheter
(ventriculostomy)
• Allows accurate intracranial pressure measurement
• Provides access to cerebrospinal fluid for drainage or sampling
• Provides access for instillation of contrast media
• Allows reliable evaluation of intracranial compliances (volume- pressure relationships)
• Provides an additional site for infection
• Is most invasive intracranial pressure monitoring technique
• Requires frequent transducer balancing or recalibration
• Catheter may be occluded by blood clot or tissue debris
• Insertion is difficult if ventricles are small,
compressed, or displaced
• Is associated with risk of cerebrospinal fluid leakage around insertion site
• Is associated with increased risk of infection
• Provide appropriate sedatives or analgesics during catheter insertion.
• Do baseline and serial neurologic assessments.
• Measure patient's temperature at least every 4 hours.
• Notice character, amount, and turbidity of cerebrospinal fluid drainage.
• Document intracranial pressure and cerebral perfusion pressure
measurements, response to stimulation, and nursing care activities per hospital or unit protocol.
• Monitor quality of intracranial waveform.
• Monitor system and tubing for air bubbles and flush or purge system as appropriate.
• Drain cerebrospinal fluid, as indicated, to treat intracranial pressure elevation.
• Notify physician if cerebrospinal fluid drainage is not within prescribed parameters.
• Monitor insertion site for bleeding,
drainage, swelling, and cerebrospinal fluid leakage.
• Zero or calibrate device per hospital or unit protocol.
• Level transducer at foramen of Monro.
External landmarks include tragus of ear and external auditory canal, among others. Make all intracranial pressure measurements with transducer at consistent level relative to external landmarks.
• Administer sedatives or analgesics as appropriate to decrease risk of catheter dislodgement by patient movements.
• Educate patient's family as indicated.
• Notify physician if intracranial pressure or cerebral perfusion pressure is not within specified parameters.
Monitoring
Device Advantages Disadvantages Nursing Considerations Subarachnoid bolt
or Screw
• Is associated with lower infection rates than
ventriculostomy
• Is quickly and easily placed
• Can be used with small or collapsed ventricles
• Requires no penetration of brain tissue
• Has potential for dampened waveform (cerebral edema, blood or tissue debris)
• Is less accurate at high
intracranial pressure elevations
• Requires frequent balancing or recalibration, such as with position changes
• Provides no access for cerebrospinal fluid sampling
• Administer appropriate sedatives or analgesics during insertion.
• Do baseline and serial neurologic assessments.
• Measure patient's temperature at least every 4 hours.
• Monitor insertion site for bleeding,
drainage, swelling, and cerebrospinal fluid leakage.
• Monitor quality of intracranial pressure waveform.
• Document intracranial pressure and cerebral perfusion pressure
measurements and response to stimulation per hospital or unit protocol.
• Administer sedatives or analgesics, as appropriate, to decrease risk of catheter dislodgement by patient movements.
• Zero or calibrate device per hospital or unit protocol.
• Level transducer at foramen of Monro.
External landmarks include tragus of ear and external auditory canal, among others. Make all intracranial pressure measurements with transducer at consistent level relative to external landmarks.
• Educate patient's family as indicated.
• Notify physician if intracranial pressure or cerebral perfusion pressure is not within specified parameters.
Subdural or epidural catheter or sensor
• Is least invasive
• Is associated with decreased risk of infection
• Is easily and quickly placed
• May lose reliability or accuracy with increase in baseline drift over time
• Provides no access for cerebrospinal fluid drainage or sampling
• Administer appropriate sedatives or analgesics during insertion.
• Do baseline and serial neurologic assessments.
• Measure patient's temperature at least every 4 hours.
• Monitor insertion site for bleeding, drainage, and swelling.
• Monitor quality of intracranial pressure waveform and drift over time.
• Document intracranial pressure and cerebral perfusion pressure
measurements and response to stimulation per hospital or unit protocol.
• Administer sedatives or analgesics as appropriate to decrease risk of catheter dislodgement or damage by patient movements.
• Educate patient's family as indicated.
• Notify physician if intracranial pressure or cerebral perfusion pressure is not within specified parameters.
Monitoring
Device Advantages Disadvantages Nursing Considerations Fiberoptic
transducer-tipped catheter
• Can be placed in subdural or subarachnoid space, in ventricle, or directly within brain tissue
• Is easily transported
• Requires zeroing only once (during insertion)
• Has baseline drift of up to 1 mm Hg per day
• Is associated with decreased risk of infection when brain tissue is not penetrated
• Provides good- quality
intracranial pressure waveforms (less artifact than with other devices)
• Requires no adjustment in transducer level with patient changes of position
• Provides no access for cerebrospinal fluid sampling or drainage.
• Cannot be recalibrated after placement.
• Requires periodic replacement of probe
• Is easily damaged
• Administer appropriate sedatives or analgesics during insertion.
• Do baseline and serial neurologic assessments.
• Measure patient's temperature at least every 4 hours.
• Monitor insertion site for bleeding,
drainage, swelling, and cerebrospinal fluid leakage.
• Monitor quality of intracranial pressure waveform and drift over time.
• Document intracranial pressure and cerebral perfusion pressure
measurements and response to stimulation per hospital or unit protocol.
• Administer sedatives or analgesics as appropriate to decrease risk of catheter dislodgement or damage by patient movements.
• Educate patient's family as indicated.
• Notify physician if intracranial pressure or cerebral perfusion pressure is not within specified parameters.
Source: Arbour, R. (2004). Intracranial hypertension: Monitoring and nursing assessment. Critical Care Nurse, 24, 19.
PRECEPTOR EXERCISES
Discuss the following questions with your preceptor: