Page 250 - Critical Care Nursing Demystified

Chapter 5 CARE OF THE PATIENT WITH NEUROLOGICAL NEEDS 235

Systolic BP less than 90 mm Hg

Diagnostic studies indicative of edema, distortion, or hydrocephalus
2. Check that a consent form has been signed.
3. Time out to verify the identity of the patient.
4. Premedicate the patient with a sedative to prevent movement.
5. Position the patient in a high Fowler’s with the bed controls locked out.

6. Set up and maintain a meticulous sterile field; all personnel near the patient
must wear sterile gloves, mask, and hat at all times when assisting with inser-
tion and anytime during care of the site, drainage bag, or obtaining a CSF
specimen.
7. Set up an airless unprressurized monitoring system, priming the tubing
according to manufacturer’s directions without heparin. This system is similar
to an arterial line or pulmonary artery line setup but without a pressurized
bag.
8. Check that all IV lines are tight.
9. Position the transducer at the foramen of Monroe and the top of the trans-
ducer by using a level or laser level. 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.
10. If there is a drainage bag, check for order of level to be maintained so that
CSF fluid does not drain excessively or flow back into the brain causing increased
ICP.
11. Make sure all stopcocks are closed to air and open between the monitor and
patient.
12. Record the ICP once hooked to the transducer by the neurologist.
13. Calculate the CPP.
14. Document the initial pressures, characteristics of the CSF, height of the drain,
and leveling of the transducer.

This procedure is a bit tricky and it takes several times to really get comfort-
able with insertion and readings. An experienced critical care nurse and a teach-
ing neurologist help make this experience beneficial for the new nurse and the
patient.