Intracranial Pressure Monitoring Periprocedural Care

Updated: Apr 01, 2018
  • Author: Gaurav Gupta, MD, FAANS, FACS; Chief Editor: Jonathan P Miller, MD  more...
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Periprocedural Care

Patient Education & Consent

Explain the procedure to the patient and family. Consent should be obtained from the patient or a responsible family member. Obtain written consent from the patient or family per institution protocol.

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Equipment

Several prepackaged EVD kits are commercially available. Equipment includes the following:

  • Preoperative gram-positive antibiotic prophylaxis (cefuroxime 1.5 g IV before the procedure)

  • Hair clipper

  • Sterile gloves/drapes/mask

  • Chlorhexidine solution

  • Sterile fenestrated drape

  • Sterile marker for drawing standard landmarks on head for placing EVD

  • Syringe (3 mL) for local anesthetic

  • Needle (18 gauge, 3/4 in) for injecting local anesthetic

  • Local anesthetic (usually 1% lidocaine with epinephrine)

  • Skin knife/scalpel #15

  • Twist drill

  • Sterile spinal needle (18 or 20 gauge) to puncture dura

  • Ventriculostomy drain (antibiotic or nonantibiotic impregnated)

  • External drainage set/Buretrol (including drainage tubing and sterile collection bag)

  • Sterile CSF collection tubes for sending CSF as specimen

  • Suture material

  • Dressings (4X4)

  • IV pole and standard ICP transducer setup (similar to arterial-line setup that is used for measuring blood pressure)

Equipment for intraparenchymal fiberoptic catheter placement includes the following:

  • Sterile gloves/mask/gown

  • Local anesthetic (usually 1% lidocaine with epinephrine)

  • Chlorhexidine or Betadine solution

  • Sterile fenestrated drapes or towels

  • Syringe (3 mL) for local anesthetic

  • Needle (25 gauge 3/4 inch) for injecting anesthetic

  • Sterile spinal needle (18 gauge) for puncturing dura

  • Small skin retractor

  • ICP monitor "bolt" to secure the ICP fiberoptic probe

  • No. 36 drill bit (2.71-mm diameter) with safety stop

  • Spacer/guard to adjust seating depth of bolt

  • Strain relief protective sheath

  • Stylet (1.3-mm diameter) to ensure no debris in the bolt prior to inserting the fiberoptic probe

  • Hex wrench to secure the drill bit into the drill

  • Zero adjustment tool for zeroing the fiberoptic probe to the atmospheric pressure

  • Fiberoptic catheter

  • Two small plastic dressings (Tegaderm) to place on the zero-adjustment screw so it is not moved during manipulation later

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Patient Preparation

EVD placement

The procedure should be performed in an ICU only under strict sterile precautions.

A “time out” is done for correct site identification, per nursing protocol.

Perform a baseline neurological assessment.

Intraparenchymal fiberoptic catheter placement/intraparenchymal pressure monitor kit

Open the intracranial pressure monitor kit with a sterile technique and inspect expiration dates.

Perform a baseline neurological assessment.

Wash hands.

Illuminate the area.

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Anesthesia

Intraparenchymal fiberoptic catheter placement

Adequate anesthesia should be ensured for the procedure.

Positioning

The patient should be placed in a supine position.

During placement of the monitor, the physician should be comfortable, so the height of the bed should be adjusted accordingly.

Elevate the head of the bed 15-30° while keeping it in the midline position with pillows or sandbags to enhance cerebral venous outflow. Even slight movement of the head to a few degrees off midline may double the ICP.

After the procedure, an elevation of 30° is optimal for allowing brain perfusion while minimizing ICP.

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