{"id":5327,"date":"2011-07-14T20:25:30","date_gmt":"2011-07-14T20:25:30","guid":{"rendered":"http:\/\/crashtext.org\/misc\/5327.htm\/"},"modified":"2013-01-14T00:25:02","modified_gmt":"2013-01-14T05:25:02","slug":"ventriculostomies-intracranial-monitoring","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/procedures\/ventriculostomies-intracranial-monitoring.htm\/","title":{"rendered":"Neuroinvasive Intracranial Monitoring"},"content":{"rendered":"

<\/span>Venticulostomy<\/span><\/h2>\n

aka IVC EVD<\/p>\n

1.2-1.6 are acceptable INRs to place Ventric (J Trauma 2011;70:1112)<\/p>\n

SR shows perhaps we should be giving abx or using abx coated EVDs throughout time (Neurosurgery 68:996\u20131005, 2011)<\/p>\n

Ultrasound-guided EVD placement (Neurocrit Care 2012;17:255)<\/p>\n

<\/span>Insertion<\/span><\/h3>\n

Kocher’s point-12-13 cm posterior to nasion (nasal bridge) 2-3 cm lateral to midline, preferably in the non-dominant side. Correlate with mid-pupillary line and anterior to the coronal suture.<\/p>\n

Aim at tragus for A\/P and medial canthus for laterality. Should be approx perpendicular to skull at kocher’s point<\/p>\n

Usually feel a pop at 4-5 cm<\/p>\n

then soft-advance to 6.5-7<\/p>\n

Usually start drainage at 10-20 cm\/H20<\/p>\n

Can test drainage by occluding the Jugs, ICP should rise or lower the head of bed<\/p>\n

normal csf drainage 250ml or if patient is obstructed, up to 450-700<\/p>\n

<\/span>No Draining CSF<\/span><\/h3>\n

lower below head level to see if you can get 2-3 drops of CSF (no more than this should be drained)<\/p>\n

If no one way valve on drainage system, raise above patients head to see bouncing\/tidaling=indicates good CSF movement but collapsed ventricles<\/p>\n

Can flush DRAINAGE portion if visible clot or air. Make sure nurses record this as supplemental drainage.<\/p>\n

Gently aspirate with syringe with preservative free NS<\/p>\n

Gently flush 1-2 ml NS<\/p>\n

Get head CT<\/p>\n

Taking CSF samples<\/p>\n

full sterile<\/p>\n

waste 2 ml<\/p>\n

take 2 ml<\/p>\n

<\/span>Weaning<\/span><\/h2>\n

raise EVD level 5 cm\/day and monitor CSF until 20 cm<\/p>\n

after 1 day at 20cm, clamp EVD and monitor ICP for 24 hrs<\/p>\n

Obtain head CT<\/p>\n

Repeat CT before D\/c from hospital<\/p>\n

Failure of trial-ICP > 25 for 5 minutes, ICP with neuro exam change, CSF from wound or another drain site<\/p>\n

 <\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Array<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[5,8,37,19],"tags":[],"yoast_head":"\nNeuroinvasive Intracranial Monitoring - Crashing Patient<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/crashingpatient.com\/procedures\/ventriculostomies-intracranial-monitoring.htm\/\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"CrashMaster\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/crashingpatient.com\/procedures\/ventriculostomies-intracranial-monitoring.htm\/\",\"url\":\"https:\/\/crashingpatient.com\/procedures\/ventriculostomies-intracranial-monitoring.htm\/\",\"name\":\"Neuroinvasive Intracranial Monitoring - 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