Xiuyun Liu1, Margaret Griffith, Hannah J Jang, Nerissa Ko, Michele M Pelter, Jacob Abba, Maximilian Vuong, Nate Tran, Kelly Bushman, Xiao Hu. 1. Questions or comments about this article may be directed to Xiuyun Liu, PhD, at liuxiuyun1@gmail.com. He is a Postdoctoral Researcher at Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA. Margaret Griffith, BSN RN CNRN, is Nurse, Neurological Intensive Care, UCSF. Hannah J. Jang, PhD MSN RN, is Science Fellow, Institute for Nursing Excellence, UCSF Medical Center. Nerissa Ko, MD, is Professor, Department of Neurological Surgery, School of Medicine, UCSF. Michele M. Pelter, PhD RN, is Assistant Professor, Department of Physiological Nursing, School of Nursing, UCSF. Jacob Abba, BA, is Software Engineer, Department of Physiological Nursing, School of Nursing, UCSF. Maximilian Vuong, BS, is Study Coordinator, Department of Physiological Nursing, School of Nursing, UCSF. Nate Tran, MSc, is PhD Student, Department of Physiological Nursing, School of Nursing, UCSF. Kelly Bushman, BSN RN CNRN, is Nurse, Neurological Intensive Care, UCSF. Xiao Hu, PhD, is Professor, Department of Physiological Nursing, School of Nursing, and Department of Neurological Surgery, School of Medicine, UCSF; Department of Neurosurgery, School of Medicine, UCLA; and Institute of Computational Health Sciences, UCSF.
Abstract
BACKGROUND: External ventricular drain (EVD) is a standard approach for both monitoring intracranial pressure (ICP) and draining cerebrospinal fluid (CSF) for patients with subarachnoid hemorrhage. Documenting an accurate ICP value is important to assess the status of the brain, which would require the EVD system to be leveled properly and closed to CSF drainage for an adequate period. It is suggested that a minimum period of 5-minute EVD closure is needed before documenting a true ICP; however, there is no commonly agreed upon standard for documenting ICP. To obtain an insight into how well the intermittent EVD clamping procedure is performed for ICP documentation, we conducted a retrospective analysis of ICP recordings obtained through EVD from 107 patients with subarachnoid hemorrhage. METHODS: The EVD was kept open for continuous CSF drainage and then intermittently closed for ICP documentation. For each EVD closure, mean ICP, standard deviation of ICP, duration of EVD closure, and time interval between 2 adjacent EVD closures were studied. The total number of EVD closures was calculated for each patient. We developed an algorithm to evaluate whether ICP reached a new equilibrium before the EVD was reopened to drainage. The percentage of EVD closures that reach the equilibrium was calculated. RESULTS: The 107 patients had 32 755 EVD closures in total, among which 65.9% instances lasted less than 1 minute and only 16.3% of all the EVD closure episodes lasted longer than 5 minutes. The median duration of each EVD closure was 25 seconds (interquartile range, 10.2 seconds to 2.33 minutes). Only 22.9% of the EVD closures reached ICP equilibrium before EVD reopening. CONCLUSION: A standard guideline and proper training are needed for bedside nurses, and a potential tool that can render ICP trend at a proper scale at bedside would help clinicians correctly document ICP.
BACKGROUND: External ventricular drain (EVD) is a standard approach for both monitoring intracranial pressure (ICP) and draining cerebrospinal fluid (CSF) for patients with subarachnoid hemorrhage. Documenting an accurate ICP value is important to assess the status of the brain, which would require the EVD system to be leveled properly and closed to CSF drainage for an adequate period. It is suggested that a minimum period of 5-minute EVD closure is needed before documenting a true ICP; however, there is no commonly agreed upon standard for documenting ICP. To obtain an insight into how well the intermittent EVD clamping procedure is performed for ICP documentation, we conducted a retrospective analysis of ICP recordings obtained through EVD from 107 patients with subarachnoid hemorrhage. METHODS: The EVD was kept open for continuous CSF drainage and then intermittently closed for ICP documentation. For each EVD closure, mean ICP, standard deviation of ICP, duration of EVD closure, and time interval between 2 adjacent EVD closures were studied. The total number of EVD closures was calculated for each patient. We developed an algorithm to evaluate whether ICP reached a new equilibrium before the EVD was reopened to drainage. The percentage of EVD closures that reach the equilibrium was calculated. RESULTS: The 107 patients had 32 755 EVD closures in total, among which 65.9% instances lasted less than 1 minute and only 16.3% of all the EVD closure episodes lasted longer than 5 minutes. The median duration of each EVD closure was 25 seconds (interquartile range, 10.2 seconds to 2.33 minutes). Only 22.9% of the EVD closures reached ICP equilibrium before EVD reopening. CONCLUSION: A standard guideline and proper training are needed for bedside nurses, and a potential tool that can render ICP trend at a proper scale at bedside would help clinicians correctly document ICP.
Authors: E Sander Connolly; Alejandro A Rabinstein; J Ricardo Carhuapoma; Colin P Derdeyn; Jacques Dion; Randall T Higashida; Brian L Hoh; Catherine J Kirkness; Andrew M Naidech; Christopher S Ogilvy; Aman B Patel; B Gregory Thompson; Paul Vespa Journal: Stroke Date: 2012-05-03 Impact factor: 7.914
Authors: Joanna Palasz; Linda D'Antona; Sarah Farrell; Mohamed A Elborady; Laurence D Watkins; Ahmed K Toma Journal: Neurosurg Rev Date: 2021-08-26 Impact factor: 3.042