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Predictive Values for Time from Transducer Stopcock Closure to Accurate Intracranial Pressure Reading

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Abstract

Background

When using an external ventricular drain (EVD) to monitor intracranial pressure (ICP), nurses need to know how long to wait after each manipulation of the transducer before the displayed ICP value represents an accurate signal. This study explores ICP signal equilibration time (EqT) under clinical conditions.

Methods

This was a prospective ex vivo study using a simulated skull, standard EVD tubing, and a strain gauge transducer. All 270 trials simulating 90 combinations of different pressures and common clinical conditions were completed in August 2021. Each trial was recorded on video. Videos were scored using video editing software to obtain the exact start and stop time for each trial.

Results

The mean EqT was 44.90 (18.77) seconds. One hundred fifty (55.56%) observations did not reach their expected value within 60 s. The longest mean EqTs were noted when blood was present in the EVD tubing (57.67 [8.91] seconds), when air bubbles were in the tubing (57.41 [8.73] seconds), and when EVD tubing was not flat (level) (50.77 [15.43] seconds). An omnibus test comparing mean EqT for conditions with no variables manipulated (30.08 [16.07] seconds) against mean EqT for all others (47.18 [18.13] seconds) found that mean EqTs were significantly different (P < 0.001).

Conclusions

Even when no additional variables were introduced, the mean EqTs were ~ 30 s. Common clinical variables increase the length of time before a transducer connected to an EVD will provide an accurate reading. Nurses should wait at least 30 s after turning the EVD stopcock before assuming ICP value reflects accurate ICP.

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References

  1. Srinivasan VM, O’Neill BR, Jho D, Whiting DM, Oh MY. The history of external ventricular drainage. J Neurosurg. 2014;120(1):228–36. https://doi.org/10.3171/2013.6.Jns121577.

    Article  PubMed  Google Scholar 

  2. Howard RS, Kullmann DM, Hirsch NP. Admission to neurological intensive care: who, when, and why? J Neurol Neurosurg Psychiatry. 2003;74(Suppl 3):iii2–9. https://doi.org/10.1136/jnnp.74.suppl_3.iii2

  3. Olson DM, Batjer HH, Abdulkadir K, Hall CE. Measuring and monitoring ICP in Neurocritical Care: results from a national practice survey. Neurocrit Care. 2014;20(1):15–20. https://doi.org/10.1007/s12028-013-9847-9.

    Article  PubMed  Google Scholar 

  4. Minor C, Tovar-Segura J, Atem FD, et al. Lack of standardization in determination of intracranial pressure. Connect World Crit Care Nurs. 2020;14(1):19–28. https://doi.org/10.1891/WFCCN-D-20-00013.

    Article  Google Scholar 

  5. Teichmann D, Lynch JC, Heldt T. Distortion of the intracranial pressure waveform by extraventricular drainage system. IEEE Trans Biomed Eng. 2021;68(5):1646–57. https://doi.org/10.1109/tbme.2020.3036283.

    Article  PubMed  Google Scholar 

  6. Liu X, Griffith M, Jang HJ, et al. Intracranial pressure monitoring via external ventricular drain: are we waiting long enough before recording the real value? J Neurosci Nurs. 2020;52(1):37–42. https://doi.org/10.1097/jnn.0000000000000487.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Rogers M, Stutzman SE, Atem FD, Sengupta S, Welch B, Olson DM. Intracranial pressure values are highly variable after cerebral spinal fluid drainage. J Neurosci Nurs J Am Assoc Neurosci Nurses. 2017;49(2):85–9. https://doi.org/10.1097/jnn.0000000000000257.

    Article  Google Scholar 

  8. Harary M, Dolmans RGF, Gormley WB. Intracranial pressure monitoring-review and avenues for development. Sensors (Basel). 2018. https://doi.org/10.3390/s18020465.

    Article  PubMed  Google Scholar 

  9. Zhang X, Medow JE, Iskandar BJ, et al. Invasive and noninvasive means of measuring intracranial pressure: a review. Physiol Meas. 2017;38(8):R143-r182. https://doi.org/10.1088/1361-6579/aa7256.

    Article  PubMed  Google Scholar 

  10. Olson DM, Lewis LS, Bader MK, et al. Significant practice pattern variations associated with intracranial pressure monitoring. J Neurosci Nurs. 2013;45(4):186–93. https://doi.org/10.1097/JNN.0b013e3182986400.

    Article  PubMed  Google Scholar 

  11. Eide PK, Sorteberg A, Meling TR, Sorteberg W. Baseline pressure errors (BPEs) extensively influence intracranial pressure scores: results of a prospective observational study. Biomed Eng Online. 2014;13:7. https://doi.org/10.1186/1475-925x-13-7.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Bothwell SW, Janigro D, Patabendige A. Cerebrospinal fluid dynamics and intracranial pressure elevation in neurological diseases. Fluids Barriers CNS. 2019;16(1):9. https://doi.org/10.1186/s12987-019-0129-6.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Johnston I, Teo C. Disorders of CSF hydrodynamics. Childs Nerv Syst. 2000;16(10–11):776–99. https://doi.org/10.1007/s003810000383.

    Article  CAS  PubMed  Google Scholar 

  14. Leinonen V, Vanninen R, Rauramaa T. Cerebrospinal fluid circulation and hydrocephalus. Handb Clin Neurol. 2017;145:39–50. https://doi.org/10.1016/b978-0-12-802395-2.00005-5.

    Article  PubMed  Google Scholar 

  15. Gerber LM, Chiu YL, Carney N, Hartl R, Ghajar J. Marked reduction in mortality in patients with severe traumatic brain injury. J Neurosurg. 2013;119(6):1583–90. https://doi.org/10.3171/2013.8.JNS13276.

    Article  PubMed  Google Scholar 

  16. Rønning P, Helseth E, Skaga NO, Stavem K, Langmoen IA. The effect of ICP monitoring in severe traumatic brain injury: a propensity score-weighted and adjusted regression approach. J Neurosurg. 2018;131(6):1896–904. https://doi.org/10.3171/2018.7.Jns18270.

    Article  PubMed  Google Scholar 

  17. Bumberger A, Braunsteiner T, Leitgeb J, Haider T. Intracranial pressure monitoring following traumatic brain injury: evaluation of indications, complications, and significance of follow-up imaging-an exploratory, retrospective study of consecutive patients at a level I trauma center. Eur J Trauma Emerg Surg. 2020. https://doi.org/10.1007/s00068-020-01570-3.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Hansen EA, Romanova L, Janson C, Lam CH. The effects of blood and blood products on the arachnoid cell. Exp Brain Res. 2017;235(6):1749–58. https://doi.org/10.1007/s00221-017-4927-2.

    Article  PubMed  Google Scholar 

  19. Muralidharan R. External ventricular drains: management and complications. Surg Neurol Int. 2015;6(Suppl 6):S271–4. https://doi.org/10.4103/2152-7806.157620.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Fujiwara SJL, Tachihara K, Mori S, et al. Influence of the marvelous™ three-way stopcock on the natural frequency and damping coefficient in blood pressure transducer kits. J Clin Monit Comput. 2018;32(1):63–72. https://doi.org/10.1007/s10877-017-9979-0.

    Article  PubMed  Google Scholar 

  21. Hunziker P. Accuracy and dynamic response of disposable pressure transducer-tubing systems. Can J Anaesth. 1987;34(4):409–14. https://doi.org/10.1007/bf03010146.

    Article  CAS  PubMed  Google Scholar 

  22. Beidler PG, Novokhodko A, Prolo LM, Browd S, Lutz BR. Fluidic considerations of measuring intracranial pressure using an open external ventricular drain. Cureus. 2021;13(5):e15324. https://doi.org/10.7759/cureus.15324.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Jangra K, Bhagat H, Panda N. Raised ICP and brain herniation. In: Bidkar PU, Vanamoorthy P, editors. Acute neuro care: focused approach to neuroemergencies. Singapore: Springer; 2020. p. 117–37.

    Chapter  Google Scholar 

  24. Stout DE, Cortes MX, Aiyagari V, Olson DM. Management of external ventricular drains during intrahospital transport for radiographic imaging. J Radiol Nurs. 2018. https://doi.org/10.1016/j.jradnu.2019.01.004.

    Article  Google Scholar 

  25. Samudra NP, Park SM, Gray SE, Sebai MA, Olson DM. Inconsistency in reporting variables related to intracranial pressure measurement in scientific literature. J Nurs Meas. 2018;26(3):415–24. https://doi.org/10.1891/1061-3749.26.3.415.

    Article  PubMed  Google Scholar 

  26. Chung DY, Mayer SA, Rordorf GA. External ventricular drains after subarachnoid hemorrhage: is less more? Neurocrit Care. 2018;28(2):157–61. https://doi.org/10.1007/s12028-017-0443-2.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Olson DM, Parcon C, Santos A, Santos G, Delabar R, Stutzman SE. A novel approach to explore how nursing care affects intracranial pressure. Am J Crit Care. 2017;26(2):136–9. https://doi.org/10.4037/ajcc2017410.

    Article  PubMed  Google Scholar 

  28. Olson DM, Rogers MS, Stutzman SE. Electronic medical record validation: exploring the reliability of intracranial pressure data abstracted from the electronic medical record-pilot. J Nurs Meas. 2015;23(3):532–40. https://doi.org/10.1891/1061-3749.23.3.532.

    Article  PubMed  Google Scholar 

  29. Olson DM, Ortega Peréz S, Ramsay J, et al. Differentiate the source and site of intracranial pressure measurements using more precise nomenclature. Neurocrit Care. 2019;30(2):239–43. https://doi.org/10.1007/s12028-018-0613-x.

    Article  PubMed  Google Scholar 

  30. Cohen JF, Korevaar DA, Altman DG, et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open. 2016;6(11):e012799. https://doi.org/10.1136/bmjopen-2016-012799.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Rothman KJ. No adjustments are needed for multiple comparisons. Epidemiology. 1990;1(1):43–6.

    Article  CAS  PubMed  Google Scholar 

  32. Olson DM, Atem F, Busch DR. Evaluation of a new catheter for simultaneous intracranial pressure monitoring and cerebral spinal fluid drainage: a pilot study. Neurocrit Care. 2019;31(1):225–6. https://doi.org/10.1007/s12028-019-00722-7.

    Article  PubMed  Google Scholar 

  33. Wolf MS, Rakkar J, Horvat CM, et al. Assessment of dynamic intracranial compliance in children with severe traumatic brain injury: proof-of-concept. Neurocrit Care. 2021;34(1):209–17. https://doi.org/10.1007/s12028-020-01004-3.

    Article  CAS  PubMed  Google Scholar 

  34. Darrow D, Lee-Norris A, Larson A, Samadani U, Netoff TI. Discrepancy between internal and external intracranial pressure transducers: quantification of an old source of error in EVDs? World neurosurgery. 2020;133:e18–25. https://doi.org/10.1016/j.wneu.2019.07.213.

    Article  PubMed  Google Scholar 

  35. Pratt KA, Peacock SH, Yost KD, Freeman WD, Collins CI, McLaughlin DC. Zero-calibrating external ventricular drains: exploring practice. J Neurosci Nurs J Am Assoc Neurosci Nurses. 2022;54(1):2–5. https://doi.org/10.1097/jnn.0000000000000622.

    Article  Google Scholar 

  36. Siaron KB, Cortes MX, Stutzman SE, Venkatachalam A, Ahmed KM, Olson DM. Blood pressure measurements are site dependent in a cohort of patients with neurological illness. Sci Rep. 2020;10(1):3382. https://doi.org/10.1038/s41598-020-60414-7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. von der Mosel HA. Principles of biomedical engineering for nursing staff. Oxford: Blackwell Scientific Publications; 1994.

    Google Scholar 

  38. Clark JW. Medical instrumentation: application and design. 4th ed. New York: Wiley; 2010.

    Google Scholar 

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Authors and Affiliations

  1. Texas Woman’s University, Dallas, TX, USA

    Corrie Earthman & Jennifer Wilson

  2. University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA

    Kathrina Siaron & DaiWai M. Olson

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  1. Corrie Earthman
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  4. DaiWai M. Olson
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Contributions

Conception: CE, JW, and DO. Design: CE, JW, and DO. Acquisition of data: CE and DO. Data analysis: CE and DO. Data interpretation: CE, KS, JW, and DO. Manuscript draft: CE, KS, JW, and DO. Critical revisions to the manuscript: CE, KS, JW, and DO.

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Correspondence to DaiWai M. Olson.

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Earthman, C., Siaron, K., Wilson, J. et al. Predictive Values for Time from Transducer Stopcock Closure to Accurate Intracranial Pressure Reading. Neurocrit Care 38, 422–428 (2023). https://doi.org/10.1007/s12028-022-01581-5

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  • DOI: https://doi.org/10.1007/s12028-022-01581-5

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