1. Obtain the Catheter (choose one of 3 types below):

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1 Checklist fr Insertin and Setup f an ICP Mnitring Device Befre prceeding, cntact neursurgery t identify the type f catheter t be inserted. The catheter type will define the equipment requirements and preparatin needed. 1. Obtain the Catheter (chse ne f 3 types belw): A. Cdman Micrsensrs (tw types): Cdman Micrsensrs are catheters that measure intracranial pressure via a strain guage micrchip lcated at the tip f the catheter. Bth Micrsensr catheters belw are cnnected t the Cdman Express fr pressure mnitring. Unlike fluid filled pressure mnitring, pressure transmissin is unaffected by bstructed fluid paths (e.g., frm clt r tissue). I. Cdman Micrsensr Intraparenchymal Catheter (pressure nly, n drainage): This catheter is inserted int superficial brain tissue. It measures pressure nly, it des nt drain CSF. It may be used fr mnitring when ventricles are t small t access, r in patients with nrmal intracranial pressure wh are at risk t develp elevated pressures. If ICP rises, it may be changed t an II. Cdman Micrsensr Intraventricular Drainage Catheter (pressure measured independent f fluid filled channel): This is an intraventicular catheter. It is used t measure ICP and t drain CSF. 1

2 B. Standard Intraventricular Drainage Catheter (fluid filled pressure mnitring): The standard ventricular catheter is used t measure ICP and t drain CSF. Pressure is measured using a standard tranducer, picking up pressure that is transmitted thrugh the fluid filled channel f the catheter. 2. Obtain supplies t insert ICP Catheter: Ventricular Drainage Tray (ensure drill is packaged with tray) Hair clipper with clipper head Line cart Sterile gwns Large sterile drape and sterile twels Lcal anaesthetic Tegaderm dressing 3. D yu need a CSF drainage unit (Cdman EDS 3)? Bth the Cdman Micrsensr venticular drainage catheter and the standard ventricular drainage catheter require a CSF drainage unit. There is n drainage f CSF with an intraparenchymal catheter. Supplies Needed: Cdman EDS 3 Standard pressure transducer kit (used t flush drainage unit) 500 ml bag f nrmal saline Cdman laser level Prtable IV ple 4. Obtain supplies fr pressure mnitring: Micrsensr catheters (intraparenchymal r intraventricular): Cdman Express mnitr Cdman Express cable (shuld be attached t Cdman Express ) Cdman -Datex pressure cable fr transferring pressure frm the Cdman Express t the Datex mnitr (Datex end f cable is red) Datex pressure mdule (e.g., P3, P4 r an unused P2) Standard Intraventricular Drainage Catheter: Datex pressure mdule (e.g., P3, P4 r an unused P2) Datex regular pressure cable Pressure transducer (als used t prime Cdman EDS3 drainage unit) 2

3 PROCEDURE FOR PRIMING CODMAN EDS3 (CSF cllectin unit): Fr Cdman Micrsensr ventricular drainage catheter and standard ventricular drainage catheter. Perfrm hand hygiene Hang the Cdman EDS3 n IV ple Prime pressure tubing with nrmal saline (d nt pressurize saline bag) Cnnect pressure tubing t the Cdman EDS3 stpcck that is clsest t the patient catheter Flush drainage tubing tward patient catheter cnnectin, then int CSF cllectin chamber 3

4 Turn patient stpcck t 45 degrees (ff in all directins) until ready t hk up Using laser level, adjust psitin f drainage unit until 0 n drainage panel is level with external auditry canal Psitin the drip chamber t the rdered level (be sure the rders clearly identify whether the rder is fr cmh 2 0 r mmhg 4

5 PROCEDURE FOR SETUP UP OF CODMAN EXPRESS Fr bth Cdman Micrsensr Catheters Perfrm hand hygiene Place Cdman Express n IV ple and plug int red electrical utlet Turn Cdman Express n and listen fr audi beep Assist physician t prepare sterile field and pen Cdman Micrsensr catheter Cnnect Micrsensr t Cdman Express cable As sn as cable is cnnected, Transducer Detected will appear n the screen Prvide physician with a syringe f sterile saline. This will be used t fill the catheter tray and submerge the tip f the catheter during zering. With catheter in the hrizntal psitin and submerged in 3 inches f sterile saline, press the blue Zer buttn when prmpted 5

6 When zering is cmpleted, a 3 digit reference number will display Dcument the 3 digit reference number in the Kardex and AI recrd. Recrd the number n the Micrsensr with a Sharpie Press MENU/ENTER Catheter can nw be inserted; the pressure will autmatically display n the Cdman Express PROCEDURE FOR CONNECTING CODMAN EXPRESS TO DATEX MONITOR Fr bth Cdman Micrsensr Catheters ICP is measured by the Cdman Express. This pressure can be duplicated n the Datex mnitr fr the purpse f generating an ICP wavefrm. 6

7 Select a pressure mdule fr ICP mnitring. This can be a P1, P2, P3 r P4. If yu chse a P3 pressure mdule: G t the admit patient menu f the Datex mnitr Chse Mdes Chse CCTC Neur This mde will default the P3 t ICP mnitring. It will als print wavefrms displayed frm P3 frm a snapsht. If yu add a P3 mdule t a CCTC General Mde, yu will nt be able t print the wavefrm. Any wave measured n a P1, P2 r P4 will print frm a snapsht in the CCTC General mde. Yu MUST label the ICP wavefrm as ICP and the arterial wavefrm must be measured frm a P1 and labeled Art fr the Cerebral Perfusin Pressure t autmatically calculate. Cnnect the Cdman Express t the Datex mnitr Obtain the Cdman t Datex cable Remve any cables frm the pressure bx yu plan t use fr ICP mnitring (P1, P2, P3 r P4). Remve any existing pressure cable frm the Datex mdule. Cnnect the red rimmed Cdman t Datex cable int the Datex pressure mdule. The black end cnnects t the back f the Cdman. Trubleshting Tip If pressing the zer patient mnitr n the Cdman Express des nt result in a message t cnfirm zer r zer bedside mnitr, check t ensure that bth ends f the cable are crrectly cnnected. 7

8 When prmpted (n the Cdman Express screen), press the Zer buttn n the Datex mdule. (Nte that yu d nt need t pen any stpccks r adjust the psitin f any tubing r devices). Cnfirm that the reference line fr the ICP wavefrm is displaying zer and the reference line is alng the zer baseline When prmpted (n the Cdman Express screen), cnfirm that the mnitr is reading zer by selecting the MENU/ENTER buttn When prmpted t chse the calibratin signal, select the 20 buttn. Cnfirm that the bedside mnitr has a reference line at 20 mmhg and then press the MENU/ENTER key t verify If the pressure is nt crrect, use the arrw keys t adjust the reference line befre pressing MENU/ENTER. 8

9 PROCEDURE FOR MONITORING ICP WITH STANDARD VENTRICULAR CATHETER: ICP is measured with standard transducer and fluid filled circuit. Perfrm hand hygiene After priming the Cdman EDS3, cnnect the pressure transducer cable t a bedside Datex mdule (e.g., P3, P4 r a spare P2) Change the Mdule label t ICP Tape the transducer t the back f the Cdman EDS3 aligning the stpcck frm the transducer with the zer reference stpcck n the Cdman EDS3. Cnfirm that the stpccks are level with the patient s external auditry canal using a laser level Zer the transducer Please nte the fllwing: An LCD switch is lcated n the back f the ICP Express t see screen in the dark Alarms are autmatically ff when ICP express is turned n. T activate alarms g t menu/enter buttn, chse n/ff alarm limits ptin and activate alarm ptin by arrwing up r dwn fr required limits. Trubleshting When zering the ICP Express mnitr, if the value -99 appears this means the grey cable that cnnects t the frnt f the ICP Express mnitr needs t be replaced If yu attempt t zer the bedside mnitr by selecting the zer patient mnitr buttn n the Cdman express and nthing changes, check t ensure the cable frm the Cdman express is cnnected int a Datex pressure mdule If a zer reference number appears befre zering, turn ICP Express ff and restart steps Traveling Discnnect catheter frm grey cable attached t ICP Express When recnnecting catheter t ICP Express, the reference number n the mnitr must match the number written n the catheter. Either accept the displayed reference number (if they match) r adjust. G t menu/enter and use arrw key t chse the crrect reference number The Cdman Micrsensr is MRI cmpatible Judy Hackett RN BScN CNCC(c) Clinical Educatr, CCTC June 12, Revised April 7, 2010 (BM); Revised May 28, 2010 (BM), Octber 12, 2016 (BM) 9