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Intracranial Pressure Monitoring Using the Codman Intraparenchymal Sensor (Adult and Pediatric) (6.15)

Intracranial Pressure Monitoring Using the Codman Intraparenchymal Sensor (Adult and Pediatric) (6.15) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Neurologic

6.15

NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
October 8, 2015

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 6.15AP

Original
Revision

Page
1
of 4

Title: Intracranial Pressure Monitoring Using
the Codman Intraparenchymal Sensor (Adult
& Pediatric)

I. PURPOSE

To continuously monitor intracranial pressure (ICP) using the Codman ICP Express
Monitor.

II. POLICY

The physician is responsible for insertion and discontinuation of the intraparenchymal
ICP sensor. Use of the Codman intraparenchymal ICP monitoring system is limited to
critical care areas, the operating room, and emergency department.

MRI Considerations (Refer to MRI Safety of the Codman® Microsensor ICP
Transducer in the Related Resources section.)

III. EQUIPMENT

A. Small bore reusable drill tray according to physician preference (available from
Reprocessing)
B. ICP insertion tray if using disposable drill (available from Reprocessing) (CS
#4001540)
C. Codman sensor (CS #2200336)
D. Codman ICP Express monitor with cables (stored in TLC, Neuro ICU, ED,
Pediatric ICU)
E. Sterile towels
F. Mask
G. Sterile gloves
H. Chlorhexidine
I. 4x4 gauze sponges
J. Hair clippers (preferred) or razor
K. 1% lidocaine with epinephrine vial
L. Tape
M. Benzoin (optional)
N. 2x2 gauze sponges
O. Sterile preservative free normal saline
P. Sterile specimen cup (optional)
Q. Skin stapler (physician preference)





Page 2 of 4

IV. PROCEDURE

A. Insertion
1. Check physician's order to determine need for intraparenchymal ICP
monitoring. Indications include: closed head injury, ruptured cerebral
aneurysm, cerebral edema or diagnosis of neurosurgical disease processes.
2. Assist the physician to assemble above equipment.
3. Position patient supine with head of bed elevated according to physician
order.
4. Assist physician as necessary. Perform universal protocol (refer to
UWHC Hospital Administrative policy 8.48, Operative, Invasive and
Other Procedures). Physician will clip hair (preferred), prep area with
chlorhexidine, drape area, and make standard burr hole through which
sensor will be inserted.
B. Initiation of Codman ICP Express Monitor
1. Zeroing the MICROSENSOR
a. Turn the ICP EXPRESS on.
b. Connect a sterile Codman MICROSENSOR Transducer to the gray
ICP EXPRESS cable in the front panel of the ICP EXPRESS.
Avoid contact with the transducer tip to avoid contamination.
c. Wait for the prompt "PRESS ZERO TO ZERO TRANSDUCER”.
d. Pour a small pool of preservative free sterile saline into the
MICROSENSOR tray. Place the gray tip of the Codman
MICROSENSOR just below the surface of the fluid.
e. Press the BLUE ZERO key on the ICP EXPRESS.
f. Record the three-digit Zero Reference Number on a piece of tape
on the MICROSENSOR itself. Add Codman to I/O/Drains
flowsheet in patient’s clinical record. Record the reference number
in the appropriate property rows.
g. Press the MENU/ENTER key to proceed.
h. With the Codman MICROSENSOR tip still in the sterile fluid,
verify that the ICP EXPRESS shows a mean pressure reading of 0
mmHg (± 1 mmHg). If not, follow from step “e”.
i. The microsensor is ready for the physician to implant.
2. Connecting to a Bedside Monitor
a. After the implant is complete, connect the ICP EXPRESS to a
bedside monitor using the appropriate interface cable.
b. The ICP EXPRESS will prompt "PROCEED TO ZERO THE
PATIENT MONITOR." Zero the bedside monitor according to the
manufacturer instructions.
c. Press the MENU/ENTER key when the bedside monitor displays
"0".
d. The ICP EXPRESS will prompt "PRESS THE 20 OR 100 KEY
FOR PATIENT MONITOR CALIBRATION." Press either key to
send a test signal to the bedside monitor.
e. Verify that the bedside monitor reads the correct pressure (20
mmHg or 100 mmHg). Press the MENU/ENTER key to return to
monitoring.


Page 3 of 4

3. Add Codman under neuro monitoring section of complex monitoring
flowsheet in patient’s clinical record. Add the location, ICP, CPP, and
waveform characteristics rows. Document ICP and neuro assessment as
ordered by physician. Notify physician of changes in ICP according to
parameters set in the MD order.
C. Transport of the Patient with Codman Express
1. Disconnect the Codman Express monitor from bedside monitor.
2. Monitor position of sensor cable during transport or patient repositioning
to prevent accidental dislodgment of sensor.
3. The patient may go to MRI with a sensor in place. The Codman Express
monitor and cables should remain outside the MRI suite. Turn the Codman
Express monitor to "STANDBY" and disconnect the sensor wire from the
monitor. MRI may ask to call MD to verify the Codman ICP monitor is
not coiled more than one time around the patient's head.
4. When the patient has returned to the home unit, reconnect the ICP express
monitor to the bedside monitor. Zero bedside monitor as instructed in
section B.2.
D. Verifying the Zero Reference Number if the Codman ICP Express Monitor is
Switched
1. Press the MENU/ENTER key on the ICP EXPRESS monitor.
2. Highlight MANUAL ZERO, using the up or down arrow keys to match the
reference number. Press MENU/ENTER.
3. The number in the ICP EXPRESS must match the number recorded for the
Codman MICROSENSOR. Reference number is recorded in the
properties section of Codman LDA in the I/O/Drains flowsheet. Use
the up or down arrow keys to adjust the number showing on the ICP
EXPRESS. Press MENU/ENTER when the numbers correlate.
E. Discontinuation of the Sensor and Pressure Monitoring System
1. Check physician order to discontinue ICP monitoring.
2. Sensor removal from the patient is a physician responsibility. Incision will
be closed with staples, suture, or dermabond. Assist with removal as
necessary.
3. Disconnect sensor wire from interface cable. Discard sensor. Keep cables
connected to box. Use hospital disinfectant wipes to clean Codman
monitor and all cables. Return Codman to the appropriate unit. Do not
send to Central Services or reprocessing.
4. Apply sterile occlusive gauze dressing to the insertion site. Document
appearance of suture line and amount and character of drainage.
5. Document the sensor removal in patient’s clinical record.

V. UWHC CROSS REFERENCES

A. Hospital Administrative policy 8.48, Operative, Invasive and Other Procedures
B. MRI Safety of the Codman® Microsensor ICP Transducer (see Related
Resources)





Page 4 of 4



VI. REFERENCES

A. Blissitt Patricia A. (2016). Hemodynamic and Intracranial Dynamic Monitoring
in Neurocritical Care, In Lough, Mary E. AACN Manual for Hemondynamic
Monitoring for Critical Care. St. Louis, MO: Saunders Elservier, 633-665.
B. Codman ICP Monitoring Guide, Johnson & Johnson
C. Slazinski, T., Anderson, T. A., Cattell, E., Eigsti, J. E., Heimsoth, S., Holleman,
& et al. (2014). Care of the patient undergoing intracranial pressure
monitoring/external ventricular drainage or lumbar drainage: AANN clinical
practice guideline series. Glenview, IL: American Association of Neuroscience
Nurses. Retrieved from www.aann.org.
D. Slazinski, T. (2011). Intracranial bolt and fiberoptic catheter insertion (assist),
intracranial pressure monitoring, care, troubleshooting, and removal. In Lynn-
McHale Wiegand, D. (Ed.), AACN procedure manual for critical care (pp. 802-
808). Philadelphia, PA: Saunders.

VII. REVIEWED BY

Clinical Nurse Manager, Neurosciences ICU
Nursing Patient Care Policy and Procedure Committee, August 2015

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President Patient Care Services, Chief Nursing Officer