Intracranial Pressure Monitoring Overview

Sep 25, 2024

Monitoring Intracranial Pressure and Brain Assessment

Overview

  • Focus: Discussion on brain areas & devices for intracranial pressure (ICP) monitoring.
  • Relevance: Complements physical assessment in neurologically impaired patients.
  • Purpose: To monitor and manage increased ICP effectively.

Areas of the Brain for ICP Assessment

  • Interventricular Space
  • Subarachnoid Space
  • Epidural Space
  • Intraparachymal Space

Devices for Monitoring ICP

  • Installation Method: All devices inserted through a burr hole (keyhole craniotomy) using a twist drill.
  • Function: Devices connect to an electronic transducer, converting ICP readings to electrical impulses for monitor display.

1. Intraventricular Catheter

  • Location: Inserted into anterior horn of lateral ventricle (non-dominant hemisphere).
  • Advantages:
    • Accurate ICP monitoring.
    • Access to cerebrospinal fluid (CSF) for drainage or testing.
  • Disadvantages:
    • Infection risk.
    • Most invasive method.

2. Subarachnoid Bolt/Screw

  • Location: Placed in subarachnoid space.
  • Advantages:
    • Easy placement.
    • Suitable for small/collapsed ventricles.
  • Disadvantages:
    • Less accurate at high ICP levels.
    • Risk of occlusion by blood/tissue.

3. Subdural/Epidural Catheters

  • Differences:
    • Epidural: Between skull and dura (dura intact).
    • Subdural: Under dura.
  • Advantages:
    • Less invasive.
    • Quick placement.
    • Lower infection risk.
  • Disadvantages:
    • No CSF access.

4. Transducer-Tipped Catheters

  • Placement: Can be in subdural, subarachnoid, ventricle, or brain tissue.
  • Advantages:
    • Versatile placement.
    • Easy transport.
  • Disadvantages:
    • Monitoring only, no CSF access.

Visual Aids

  • Intraventricular Catheter: Shows catheter placement and CSF drainage.
  • Figure 42-1: Displays device locations in brain and their spatial relations.
  • Epidural/Subdural Hematomas: Illustrates bleeding between respective brain layers.

Monitoring Systems

  • Camino Monitoring System: Used in Medical Center and Flowers facility.
    • Converts ICP to electrical impulses.
    • Monitors display strips indicating ICP levels (P1, P2, P3 peaks).
    • Rising ICP: Peaks form a hill/mountain shape on monitor.

Summary

  • Importance of knowing different monitoring devices and their applications.
  • Understanding ICP monitoring aids in early detection and management of increased intracranial pressure.