Accuracy of Levelling Intraventricular Collection Drainage Systems

Bisnaire, D; Robinson, Lynda

doi:10.1097/01376517-199708000-00008

Cited by 11 publications

(7 citation statements)

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“…[ 5 ] When positioning an EVD, the nurse adjusts the height of the EVD such that its pressure transducer is in line with the Foramen of Monro, which falls at the level of the external auditory meatus of the ear in the supine position and at the mid sagittal line (between the eyebrows) in the lateral position. [ 2 ] Tools such as a Carpenter's level or laser leveling device is used to zero the drain at this level and assure accuracy of placement, as leveling based on visual checks alone are often inaccurate. [ 2 ] Next the drip chamber is adjusted to the desired height level, before unclamping the chamber.…”

Section: Introductionmentioning

confidence: 99%

“…[ 2 ] Tools such as a Carpenter's level or laser leveling device is used to zero the drain at this level and assure accuracy of placement, as leveling based on visual checks alone are often inaccurate. [ 2 ] Next the drip chamber is adjusted to the desired height level, before unclamping the chamber. At this prescribed height, CSF will drain whenever the interventricular pressure exceeds that set by the height of the collection system.…”

Section: Introductionmentioning

confidence: 99%

“…As a result, the collection system must be re-leveled whenever the patient changes position to avoid erroneous ICP reading and/or over or under drainage. [ 2 ] For example, if the transducer is above the Foramen of Monro, falsely low ICP and insufficient drainage of CSF may occur, in which case intracranial hypertension would go undetected and untreated. In addition, drain should also be clamped during transfer and transport.…”

Section: Introductionmentioning

confidence: 99%

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External ventricular drains: Management and complications

2015

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Background:Insertion of an External Ventricular Drain (EVD) is arguably one of the most common and important lifesaving procedures in neurologic intensive care unit. Various forms of acute brain injury benefit from the continuous intracranial pressure (ICP) monitoring and cerebrospinal fluid (CSF) diversion provided by an EVD. After insertion, EVD monitoring, maintenance and troubleshooting essentially become a nursing responsibility.Methods:Articles pertaining to EVD placement, management, and complications were identified from PubMed electronic database.Results:Typically placed at the bedside by a neurosurgeon or neurointensivist using surface landmarks under emergent conditions, this procedure has the ability to drain blood and CSF to mitigate intracranial hypertension, continuously monitor intracranial pressure, and instill medications. Nursing should ensure proper zeroing, placement, sterility, and integrity of the EVD collecting system. ICP waveform analysis and close monitoring of CSF drainage are extremely important and can affect clinical outcomes of patients. In some institutions, nursing may also be responsible for CSF sampling and catheter irrigation.Conclusion:Maintenance, troubleshooting, and monitoring for EVD associated complications has essentially become a nursing responsibility. Accurate and accountable nursing care may have the ability to portend better outcomes in patients requiring CSF drainage.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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External ventricular drains: Management and complications

2015

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“…To put this in context, Bisnaire et al suggested an acceptable error of 2 cm for drip chamber height, which is used clinically to regulate ICP [ 9 ] and corresponds to a pressure error of 2 cmH 2 O (1.5 mmHg). Also, a literature review by Zacchetti et al found a mean error of ~2.1 cmH 2 O (1.54 mmHg) in ICP between different locations in the brain, with 30% of readings exceeding 6 cmH 2 O (4.4 mmHg) of error between locations [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…In order for pressure measurements to be accurate, the pressure transducer, which is attached at the zero point on the EVD must be placed accurately at the height of the external auditory meatus (EAM). Bisnaire et al showed that placement height error can be as great as 4.4 cm on average and is highly dependent on nurse experience and which tools they use for leveling (e.g., eyeball, string, laser level) [ 9 ]. This height error corresponds to a pressure error of 4.40 cmH 2 O (3.26 mmHg) assuming a CSF density of 1.00059 g/mL [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Fluidic Considerations of Measuring Intracranial Pressure Using an Open External Ventricular Drain

Beidler¹,

Novokhodko²,

Prolo³

et al. 2021

Cureus

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Measurement of intracranial pressure (ICP) during cerebrospinal fluid (CSF) drainage with an external ventricular drain (EVD) typically requires stopping the flow during measurement. However, there may be benefits to simultaneous ICP measurement and CSF drainage. Several studies have evaluated whether accurate ICP measurements can be obtained while the EVD is open. They report differing outcomes when it comes to error, and hypothesize several sources of error. This study presents an investigation into the fluidic sources of error for ICP measurement with concurrent drainage in an EVD.Our experiments and analytical model both show that the error in pressure measurement increases linearly with flow rate and is not clinically significant, regardless of drip chamber height. At physiologically relevant flow rates (40 mL/hr) and ICP set points (13.6 -31.3 cmH 2 O or 10 -23 mmHg), our model predicts an underestimation of 0.767 cmH 2 O (0.56 mmHg) with no observed data point showing error greater than 1.09 cmH 2 O (0.8 mmHg) in our experiment. We extrapolate our model to predict a realistic worst-case clinical scenario where we expect to see a mean maximum error of 1.06 cmH 2 O (0.78 mmHg) arising from fluidic effects within the drainage system for the most resistive catheter.Compared to other sources of error in current ICP monitoring, error in pressure measurement due to drainage flow is small and does not prohibit clinical use. However, other effects such as ventricular collapse or catheter obstruction could affect ICP measurement under continuous drainage and are not investigated in this study.

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