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External Ventricular Drains

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External Ventricular Drainage

Intracranial pressure refers to the pressure exerted by the brain, blood and cerebrospinal fluid in the skull. The normal range for ICP measurement is 0-15 mmHg. The cerebral perfusion pressure indirectly reflects the adequacy of cerebral blood flow. The CPP is derived by a mathematical calculation subtracting ICP from the mean arterial pressure (MAP). The normal range for adults is approximately 60-100 mmHg or a mean of 80 mmHg. The optimal CPP for a given patient depends on the clinical condition.

Clinical conditions that frequently result in an increased ICP are traumatic brain injury, subarachnoid hemorrhage, intraparenchymal hemorrhage, brain tumor, meningitis and hydrocephalus. Increasing ICP causes decrease CPP, impaired autoregulation, hypotension, hypoxemia, cerebral ischemia, hypercarbia, hyperthermia and hypo/hyperglycemia. The goal of care is to prevent the secondary brain injury that results from increased ICP. An EVD (external ventricular drain) may be indicated in these cases. It is considered the most accurate ICP monitor while allowing for drainage of CSF. The procedure to place drain may be performed at the bedside under sterile conditions or in the OR.

Nursing Considerations

* Obtain pre procedure assessment to provide baseline data including vital signs, LOC, sensation and motor function, cranial nerve function and mental status. * Obtain history of recent asprin and anticoagulation therapy. * Obtain history of prior craniotomies, aneurysm clips, embolic materials, permanent balloon occlusions, detachable clips or ventriculoperitoneal shunt. Evaluate labs for coagulopathy studies and radiology and angiography results. Report findings to MD. * -------------------------------------------------
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