Intracranial hypertension. Advances in intracranial pressure monitoring

Research is continuing to find improved methods for monitoring intracranial pressure as well as the effect of intracranial hypertension on the patient's recovery. Each of the methods of monitoring has its advantages and disadvantages and the use of one method over others is usually the preference of the neurosurgeon. It is the responsibility of the nurse to be aware of the strengths and weaknesses of each device in order to strengthen patient outcome. Again, the major benefits of the bolt are a low infection rate and easy insertion. Problems associated with its use of which the nurse should be aware are a tendency for a dampened waveform that gives an inaccurate pressure reading requiring irrigation that may or may not clear the catheter, and the inaccurate readings given by the bolt at high pressures. The subdural catheter can be used for long-term monitoring; however, baseline drift has been reported. Ventricular catheters have a mixed bag of results according to research. They are the most accurate of the methods used and enable cerebrospinal fluid to be drained, thereby lowering ICP. However, the catheters appear to have a higher infection rate. This is debatable, however. Some researchers advocate the prophylactic use of antibiotics. A closed drainage system should be used and if the device is used for longer than 4 days, the device should be changed and care should be taken to prevent leakage of cerebrospinal fluid. The devices currently in use have been presented and patient outcomes discussed using medical research, as none was available from the nursing literature.(ABSTRACT TRUNCATED AT 250 WORDS)