How do you zero Ventriculostomy?
Zeroing
- The ICP only requires ‘zeroing’ if requested by the Codman™ monitor.
- Codman™ monitor should be connected to the Phillips™ monitor via the ICP monitor cable into the transducer.
- Turn the Codman™ monitor on and press ‘0’
- On the Phillips™ monitor, press the ‘Zero’ button.
Why do we zero the EVD at the tragus?
‘Zero’ level defined by the tragus of the ear (at FORAMEN OF MAGENDIE) The objective is to use a ventriculostomy catheter and the EVD system to remove excess CSF and maintain normal CPP, while avoiding a rapid drop in ICP, which could cause re-bleeding.
Where do you zero EVD?
The zero reference point for an EVD is level with the Intraventricular Foramen (Foramen of Munro), located at the beginning of the third ventricle.
What happens if you drain too much CSF?
It is possible that the puncture of the ventricle or the opening of the dura will result in an intracranial hemorrhage. It is possible that if too much CSF is removed from the ventricles, either during a drainage procedure or when the ventricle is first punctured, the ventricle may collapse and occlude the catheter.
What is a Ventriculostomy drain?
Ventriculostomy is a neurosurgical procedure that involves creating a hole (stoma) within a cerebral ventricle for drainage. It is most commonly performed on those with hydrocephalus. It is done by surgically penetrating the skull, dura mater, and brain such that the ventricle of the brain is accessed.
What is a Ventriculostomy catheter?
Ventriculostomy is also called ventricular catherization with an intraventricular catheter (IVC) or external ventricular drainage (EVD). It is a surgical procedure that involves the placement of a catheter connecting the ventricles of the brain to an external collecting device.
What does negative ICP mean?
Abstract. Objective: Negative-pressure hydrocephalus (NegPH) is a rare clinical entity characterised by enlarged ventricles and symptoms consistent with increased intracranial pressure (ICP) in the setting of negative ICP.
What is ICP?
Intracranial pressure (ICP) is defined as the pressure within the craniospinal compartment, a closed system that comprises a fixed volume of neural tissue, blood, and cerebrospinal fluid (CSF).
What is EVD placement?
An EVD is a flexible plastic catheter placed by a neurosurgeon or neurointensivist and managed by intensive care unit (ICU) physicians and nurses. The purpose of external ventricular drainage is to divert fluid from the ventricles of the brain and allow for monitoring of intracranial pressure.
Why is a ventriculostomy done?
EVD ventriculostomy is done primarily to monitor the intracranial pressure as well as to drain cerebrospinal fluid (“CSF”), primarily, or blood to relieve pressure from the central nervous system (CNS).
When does CSF continue to drain through the ventriculostomy?
If CSF resorption is insufficient, most of the CSF continues to drain through the ventriculostomy, but if CSF resorption is sufficient, little CSF drains externally.
When do you need to remove a ventriculostomy catheter?
If a ventriculostomy is primarily used for drainage of CSF, adequate spontaneous CSF resorption must be restored before the catheter can be safely removed. CSF resorptive capacity must be gauged according to the CSF drainage rate.
Do you need ventriculostomy for pseudomeningocele resection?
Patients undergoing suboccipital craniotomy for resection of cerebellar metastases may require ventriculostomy placement. This aids safe resection by allowing for brain relaxation with intraoperative CSF diversion, but also may reduce rates of postoperative pseudomeningocele or CSF leak.
How often should I Leave my ventriculostomy drain open?
A typical order may read: “leave ventriculostomy open to drain at 15 mm Hg (20 cm CSF) above the ear and monitor ICP every hour.” ICP readings with the drain open are inaccurate, and the drainage port needs to be temporarily clamped when measuring an ICP.
