PROCEDURE: MEASUREMENT OF INTRACRANIAL PRESSURE USING FLUID FILLED PRESSURE SYSTEM

Ensure that patient and health care provider safety standards are met during this procedure including:

  • Risk assessment and appropriate PPE
  • 4 Moments of Hand Hygiene
  • Procedural Safety Pause is performed
  • Two patient identification
  • Safe patient handling practices
  • Biomedical waste disposal policies
  1. Review System
  2. Level Transducer
  3. Zero Transducer

Nurses may prime and connect the intraventricular drainage system in CCTC.  All CSF draining catheters (intraventricular; lumbar ICP) must be connected to the CodmanTM External Drainage System for safety.

This procedure refers to the measurement of intracranial pressure through an external ventricular drainage catheter (EVD) using a standard fluid filled pressure transducer.

Before Proceeding

PROCEDURE

 1.

Review Equipment

1.  Primed CodmanTM  External Drainage System that is zeroed according to Procedure for Setup and Use of Codman EDS 3 External Drainage System.

2. Single pressure transducer circuit primed with normal saline and connected to the patient stopcock stopcock closest to patient catheter (as per setup of drainage system)

3. Transducer pressure cable connected to bedside monitor and "ICP" selected as presure monitoring mode.  If ICP is greater than 20 mmHg, the scale will need to be increased.

4. "0" reference on Codman EDS 3TM drainage unit panel has been leveled using a laser level (in CN cupboard)

 

Codman
Figure 1.01: Position the zero reference on the drainage panel at the level of the tragus or external auditory canal.

 2.

Level Transducer

Tape the transdcuer to the back of the CodmanTM drainage unit. Position the transducer so that the stopcock that is located above the transducer is level with the "0" marking on the Codman EDS 3TM drainage collection panel.

Taping the transducer into position will ensure that leveling of both the drainage collecting unit and pressure monitoring system can be accomplished each time the Codman EDS 3TM drainage unit is re-leveled. Leveling the drainage chamber ensures that CSF drainage will occur according to the prescribed pressure.

Note that drainage of CSF occurs when the pressure in the cranial comparment exceeds the level (in cmH20) of the drainage collecting chamber. The catheter must also be patent and there must be CSF in the ventricle for drainage to occur.

The bedside monitor will display the ICP in mmHg, but the drainage position is ordered in cmH20.  The Codman drainage collection unit identifies drain levels in both cmH20 and mmHg to demonstrate equivalent readings.

For example, if the drain is set to a level of 10 cmH20, a drainage gradient occurs if the pressure in the head is greater than 10 cmH20 or 7.4 mmHg (equivalent bedside pressure).

level transducer
Figure 1.02: Tape the transducer to be level with the zero reference point on the drainage unit.

Turn laser level on while positioned in laser holder on Codman EDS 3TM drainage collection system.  Adjust panel until the laser beam is directed into external auditory canal.

 

level
Figure 1.03: Use laser light to level the zero reference point with the tragus.

 3.

Zero Transducer

  1. Perform hand hygiene

  2. Ensure stopcock located above transducer is level with "0" on Codman EDS 3TM panel and patient's tragus

  3. Remove the luer lock cap on the stopcock

  4. Turn the stopcock "off" toward the patient monitoring tubing (hard non-compliant tubing)

  5. Press "zero" on the bedside pressure monitoring module
  6. Confirm that the pressure waveform displayed is resting on the "zero" line of the pressure display
  7. Turn stopcock back to monitoring position
  8. Replace cap with non-vented luer lock cap
  9. Reconfirm level with each pressure measurement

 

Zero
Figure 1.04: Zero the ICP module of the bedside monitor.

 

 

Developed by:
Brenda Morgan

CNS, CCTC
Created: November 1988

Last Update: February 1, 2020