Caring for a Patient with an External Ventriculostomy (Intraventricular Catheter–Closed Fluid-Filled System)

Goal: The patient maintains intracranial pressure at less than 10 to 15 mm Hg, and cerebral perfusion pressure at 60 to 90 mm Hg.

1. Review the medical orders for specific information about ventriculostomy parameters.

2. Gather the necessary supplies and bring to the bedside stand or overbed table.

3. Perform hand hygiene and put on PPE, if indicated.

4. Identify the patient.

5. Close curtains around bed and close the door to the room, if possible. Explain what you are going to do and why you are going to do it to the patient.

6. Assess patient for any changes in neurologic status. (See Chapter 2, Health Assessment, for details of assessment.)

7. Assess the height of the ventriculostomy system to ensure that the stopcock is at the level of midpoint between the outer canthus of the patient’s eye and the tragus of the patient’s ear or external auditory canal (Littlejohns, 2005), using carpenter level, bubble-line level, or laser level, according to facility policy. Adjust the height of the system if needed. Move the drip chamber to the ordered height. Assess the amount of CSF in the drip chamber if the ventriculostomy is draining.

8. Zero the transducer. Turn stopcock off to the patient. Remove the cap from the transducer, being careful not to touch the end of the cap. Press and hold the calibration button on the monitor until the monitor beeps. Return the cap to the transducer. Turn the stopcock off to the drip chamber to obtain an ICP reading. After obtaining a reading, turn the stopcock off to the transducer.

9. Adjust the ventriculostomy height to prevent too much drainage, too little drainage, or inaccurate ICP readings.

10. Care for the insertion site according to the institution’s policy. Assess the site for any signs of infection, such as purulent drainage, redness, or warmth. Ensure the catheter is secured at site per facility policy.

11. Calculate the CPP, if necessary. Calculate the difference between the systemic MAP and the ICP.

12. Remove PPE, if used. Perform hand hygiene.

13. Assess ICP, MAP, and CPP at least hourly.