By Catherine Bell and Andrew Udy Catherine Bell takes us through how to troubleshoot problems commonly encountered when looking after patients who have an external ventricular drain (EVD) in situ. Issues with using brain tissue oxygen monitors are also discussed. A highly practical session aimed at bedside clinicians.

1. EVD TIPS AND
TRICKS
BY Catherine Bell

2. IS IT BEFORE THE…
THE MONITORING
DEVICE…
OR AFTER THE…

3. EVD TIPS
Not draining or zeroing?
 check the priming port
is open
No CSF drainage?
 blocked,
 kinked,
 malposition
Was it zeroed correctly?
 Right height ie EAM
 Turned off to the patient
 Burette at zero level
1
2
3
CHECKED ALL OF THE ABOVE -> CALL THE NEUROSURGERY
TEAM….THEIR TURN!

4. CODMAN – FIBREOPTIC
SENSORS
CHECKED ALL OF THE ABOVE -> CALL THE NEUROSURGERY
TEAM….THEIR TURN!
EASILY
DAMAGED!
STRETCHING
KINK
STAPLED
MOISTURE
MONITOR NOT TURNING ON?
 CHECK THE BATTERY OR PLUGGED
IN
WILL NOT ZERO?
 CHECK THE MICROSENSOR
 CHECK THE CABLES
 IS THE TRANSDUCER
RECOGNISED?
 NO – A BRICK OR CABLE
ISSUE
 NO – IS THE ICP LABEL
ACTIVE OR NOT?
 DID YOU ZERO IT TO THE
MONITOR – WHAT ?
PICTURE TO BE ADDED

5. PbtO2 TIPS
Is the number reliable?
 Setup correct (Smart Card)
 Adequate dwell time
 Passed a “FiO2” challenge
 Adequately positioned
(interval CT scan)
1

6. PbtO2 TIPS
1
Avoiding dislodgement
 Adequate cruciate durotomy on
insertion
 Ensure all connections are
secure
 Care with patient movement /
transport
 Ensure not “pulling” or tethered
CSF Leak
 Wing nut overly tight