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External Ventricular Catheters

Is It Appropriate to Use an Open/Monitor Position to Adequately Trend Intracranial Pressure in a Neuroscience Critical Care Environment?

Sunderland, Nicole E.; Villanueva, Nancy E.; Pazuchanics, Susan J.

Journal of Neuroscience Nursing: October 2016 - Volume 48 - Issue 5 - p 274–277
doi: 10.1097/JNN.0000000000000255

ABSTRACT Intracranial pressure (ICP) monitoring can be an important assessment tool in critically and acutely ill patients. An external ventricular drain offers a comprehensive way to monitor ICP and drain cerebrospinal fluid. The Monro-Kellie hypothesis, Pascal’s principle, and fluid dynamics were used to formulate an assumption that an open/monitor position on the stopcock is an adequate trending measure for ICP monitoring while concurrently draining cerebrospinal fluid. Data were collected from 50 patients and totaled 1053 separate number sets. The open/monitor position was compared with the clamped position every hour. An order for “open to drain” was needed for appropriate measurement and nursing care. Results showed the absolute average differences between open/monitor and clamped positions at 1.6268 mm Hg. This finding suggests that it is appropriate to use an open/monitor position via an external ventricular drain for adequate trending of patients’ ICP.

Nancy E. Villanueva, PhD CRNP BC CNRN, is Neurosurgery Nurse Practitioner, Department of Neurosurgery, Temple University Health System, Philadelphia, PA.

Susan J. Pazuchanics, MSN RN CCRN NE-BC, is Clinical Nurse Educator, Department of Nursing, Penn State Milton S. Hershey Medical Center, Hershey, PA.

Questions or comments about this article may be directed to Nicole E. Sunderland, MSN RN SCRN CCRN, at She is a Clinical Nurse, Neuroscience Critical Care Unit, Department of Nursing, Penn State Milton S. Hershey Medical Center, Hershey, PA.

The authors declare no conflicts of interest.

© 2016 American Association of Neuroscience Nurses