INTRA CRANIAL PRESSURE MONITORING

INTRA CRANIAL PRESSURE (ICP) MONITORING 

An ICP monitor is a device inserted into the cranial cavity that records pressure and is connected to a monitor that shows a picture of the pressure waveform. 

• Monitoring ICP facilitates continual assessment and is more precise than vague clinical manifestation. 
• The insertion procedure is always performed by a neurosurgeon in the operating room, emergency department, or critical care unit. This procedure is rarely used unless the client is comatose, so there is minimal need for pain medication and pre procedure teaching. 

Three basic types of ICP monitoring system 

• Intraventricular catheter(also called a ventriculostomy) = A fluid-filled catheter is inserted into the anterior horn of the lateral ventricles through a burr hole.  The catheter is connected to a sterile drainage system with a three-way stopcock that allows simultaneous monitoring of pressure by a transducer connected to a bedside monitoring and drainage of CSF. 

Subarachnoid screw or bolt

• A special hollow, threaded screw or bolt is placed into the subarachnoid space through a twist-drill burr hole in the front of the skull, behind the hairline. The bolt is connected by fluid-filled tubing to a transducer levelled at the approximate location of the lateral ventricle. 

Epidural and Subdural sensor 

• A fiber-optic sensor is inserted into the epidural space through a burr hole. The fibre-optic device measure changes in the amount of light reflected from a pressure-sensitive diaphragm in the catheter tip. The cable is connected to a precalibrated monitor that displays the numerical value of ICP. This method of monitoring is noninvasive because the device does not penetrate the dura.

INDICATIONS

ICP monitoring is useful for early identification and treatment of increased intracranial pressure, Client who are comatose or have GCS score of 8 are candidate for ICP monitoring. 

Client presentation 

• Symptoms of increased ICP include  severe headache, deteriorating level of consciousness,  restlessness, irritability, dilated or pinpoint pupils, slowness to react, alterations in breathing patterns, deterioration in motor function, and abnormal posturing

Interpretation of findings 

• Normal ICP is 10 to 15 mmHg. Persistent elevation of ICP extinguishes cerebral circulation, which will result in brain death if not treated urgently.

PRE-PROCEDURE

• The head is shaved around the insertion location. The site is then cleansed with an antibacterial solution. 

INTRA PROCEDURE 

• Local anaesthetic can be used to numb the area if the clint's GCS indicate some level of consciousness 
• Insertion and care of any ICP monitoring device require a surgical aseptic technique to reduce the risk for CNS infection.

POST-PROCEDURE 

Nursing action 

• Maintain system integrity at all times. There is a risk of serious, life-threatening infection. 
• Inspect the insertion site at least every 24 hr for redness, swelling and drainage. Change the sterile dressing covering the access site per facility protocol. 
• ICP  monitoring equipment must be balanced and recalibrated per facility protocols.
• After the insertion procedure, observe ICP waveforms, nothing the pattern of waveform and monitoring for increased ICP 
• Assess the client's clinical status and monitor routine and neurologic vital signs every hour as needed.

COMPLICATIONS 

Infection  and bleeding 

• The insertion and maintenance of an ICP monitoring system can cause infection and bleeding.
• Nursing action
• Follow strict surgical aseptic techniques 
• Perform sterile dressing changes per facility protocol 
• Keep drainage system closed 
• Limit monitoring to 3to5 days
• Irrigate the system only as needed to maintain patency.