Page 249 - Critical Care Nursing Demystified

234 CRITICAL CARE NURSING DeMYSTIFIED

Intracranial Pressure Monitoring Devices

Before the patient can be attached to a monitoring device to monitor his or her
ICP, a measuring device must be inserted by a neurologist. These can be inserted
into the intraventricular, subarachnoid, or epidural spaces or into the brain
parenchyma itself. Following is a brief description of each site.

Intraventricular Small catheter inserted directly into the ventricle through the
catheter skull. Neurologist inserts the catheter through a small hole
in the brain called a burr hole. Used primarily for the
removal of CSF for diagnostic or therapeutic purposes.
Subarachnoid A small, hollow bolt or screw is inserted into this space.
bolt It does not penetrate the brain and it cannot drain CSF.
Inserted through burr hole.
Epidural sensor A small, fiber-optic sensor is placed into this space. It is the
least invasive of the catheters, easier to insert, and has a low
risk of infection. It does not penetrate the brain or the dura
and does not drain CSF. Inserted via burr hole.
Parenchyma A small, fiber-optic catheter that is inserted approximately
1 cm into the parenchyma through a subarachnoid bolt.
It cannot drain CSF. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

A popular, more versatile type of ICP monitoring system is the fiber-optic
small-transducer-tipped 4 Fr. catheter. However, this type of catheter is fragile
and vulnerable to kinks and pulls, which could then block or occlude the
function of the catheter. Figure 5–5 shows an ICP monitoring catheter and
system.

H ? How to Do It—Setting Up an ICP

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Monitoring Device
Monitoring Devic
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1. Verify that the patient is a candidate for ICP monitoring, which is usually indi-
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that the patient is a candidat
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cated by two or more of the following:
cat e d b y tw o or mor e o f the f ollo wing :
Age greater than 40
A g e g r e at er than 40
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Motor posturing, bilateral or unilateral decorticate or decerebrate
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