So the main goals of our medical interventions are to decrease the total volume in the cranium. Which of the following interventions are appropriate for this client? We will see pulse pressure widening. T., et al. Feel Like You Don’t Belong in Nursing School? If the patient with a Medtronic Exacta EVD requires ICP monitoring, attach and prime with 0.9% Normal Saline, via sterile procedure, attach the ICP transducer (Stores Number 7291) to the Medtronic Exacta EVD system at the three way tap parallel to the burette. Soooooo glad you asked! heart rate 44 And as ICP increases, we may also see seizures. When measuring and documenting ICP in a patient with an open EVD, it is crucial that the drainage to the burette system be clamped, enabling a true ICP reading to be obtained from the patient (otherwise the drainage pressure will be recorded). respirations 22 Once the patient has the EVD clamped, observe for signs and symptoms of increased ICP, CSF leak at dressing site and ensure the dressing is dry and intact. The ventricular system produces CSF at approximately 25ml/hr (estimated at 0.35mls/kg/hr in children) by the choroid plexus in the lateral ventricles. Exploring the guidelines for the management of severe head injury.Journal of Neuroscience Nurses 32(1): 54–60. The 3 things here are abnormal respirations, remember the brainstem is under pressure so our breathing response is affected. So Intracranial pressure or ICP is the pressure inside the cranium – or the skull. This lesson is part of the NURSING.com Nursing Student Academy. Intracranial pressure monitoring. Happy nursing! When an ICP monitor has been inserted in the operating theatre, upon admission to the recovery room or return to the PICU, NICU or Cockatoo ward, it is imperative that the patient be monitored closely with routine post anaesthetic observations as per operation notes and neurological assessment. American Association of Neuroscience Nurses: 1-3, Tippett. When it is determined that the patient can have the ICP catheter or device removed, this is performed by a member of the Neurosurgery team on the unit. The laser level device should be in line with the patient's Foramen of Monro (FOM). There are 2 ways to zero the ICP Monitor: Press the ‘Zero’ button on the monitor transducer twice, you should hear a beep/ press the ICP scale on the monito, Press zero while the EVD transducer is still open to the atmosphere. The Monro-Kellie Hypothesis tells us that the skull is a fixed box filled with brain, blood, and CSF and that if one of those increases in volume, the others must decrease or the pressure will go up. Paediatric Intensive Care Guidelines. The more this blood increases, the more and more pressure will build up because there’s nowhere for it to go! Nursing care of the patient with a GI bleed, Atelectasis care plan for nursing students. See Routine Post Anesthetic Observations Clinical Practice Guideline. Under no circumstances is a sample to be obtained via aspiration, as the risk of aspirating brain parenchyma exists. The 24 hour measurement period is midday to midday, and volumes are measured 4 hourly. So when we do see a lot of bleeding or swelling, we have some surgical options we can use to give the brain more room to expand. N.B. J., et al. Common clinical signs of early intracranial hypertension include: vomiting, irritability, headache, seizures, photophobia, lethargy, nystagmus, and diplopia. Dressings of the EVD site need to be observed hourly and this documented to ensure a leak has not occurred. If your patient needs surgical intervention, here’s what you could expect: So there you have it…an intro to managing ICP in your neuro patient. So those are the most important things you need to know about increased intracranial pressure. To enable printing with an ICP monitor, the ICP needs to be displayed on a large Phillips Screen. the Monro-Kellie doctrine. Indications for an EVD or ICP monitor can include hydrocephalus, haemorrhage, tumour, meningitis or traumatic brain injury. Master Increased Intracranial Pressure (ICP) Assessment with Picmonic for Nursing RN. Codman Monitor (ICP Express) – is a device which enables measurement of pressure via a pressure transducer and fibre optic cable but it does not have the ability to drain CSF as an EVD does. Intracranial pressure (ICP) monitoring and extraventricular drains (EVD). Which of the following is a common cause of increased intracranial pressure (ICP)? ICP will be on it. Let’s recap quickly – intracranial pressure is the pressure within the skull. We will also decrease stimuli and decrease any valsalva actions. The following are the nurse’s assessment findings: 50 Flemington Road Parkville Victoria 3052 Australia, Site Map | Copyright | Terms and Conditions, A great children's hospital, leading the way, Nursing Assessment Clinical Practice Guideline, Routine Post Anesthetic Observations Clinical Practice Guideline, External Ventricular Drains and Intracranial Pressure Monitoring evidence table, The patient is receiving anticoagulation therapy or who is known to have coagulation problems, Reportable limits are noted and adhered which is patient specific, EVD drainage point is set at the prescribed level (as per Neurosurgeon documentation in postoperative orders), EVD transducer is leveled to the patient’s external auditory meatus (Tragus), Observe and record volume level of CSF in burette. Updated April 2016. So as your ICP goes up, your CPP goes down. One of the things we can do is intentionally hyperventilate the patient – this blows off more CO2 and allows for what we call permission hypocapnia – usually a pCO2 around 30 mmHg.