Intracranial pressure

monitoring

onitoring; CSF pressure monitoring

outlines
• Definition
• How the Test is Performed
• Why the Test is Performed
• How the Test will Feel
• Normal Results
• What Abnormal Results Mean
• Risks
Definition of ICP

Intracranial pressure (ICP) monitoring uses a

device placed inside the head.

The monitor senses the pressure inside the skull

and sends measurements to a recording device.
How the Test is Performed 01 INTRAVENTRICULAR
There are four ways to monitor ICP. ICP CATHETER
is the pressure in the skull.

02 SUBDURAL SCREW (BOLT)

03 EPIDURAL SENSOR

04
INTRAVENTRICULAR CATHETER

The intraventricular catheter is the most accurate monitoring

method.
To insert an intraventricular catheter, a hole is drilled through
the skull. The catheter is inserted through the brain into the
lateral ventricle. This area of the brain contains cerebrospinal
fluid (CSF). CSF is a liquid that protects the brain and spinal
cord.
The intraventricular catheter can also be used to drain fluid out
through the catheter.
The catheter may be hard to get into place when the
intracranial pressure is high.
SUBDURAL SCREW (BOLT)

This method is used if monitoring needs to be done

right away. A hollow screw is inserted through a
hole drilled in the skull. It is placed through the
membrane that protects the brain and spinal cord
(dura mater). This allows the sensor to record from
inside the subdural space.
EPIDURAL SENSOR

An epidural sensor is inserted between the skull and dural tissue. The epidural
sensor is placed through a hole drilled in the skull. This procedure is less
invasive than other methods, but it cannot remove excess CSF.

Continuous intracranial pressure (ICP) monitoring using an epidural sensor is

a common technique used in selected neurosurgical patients.
Subarachnoid Bolt
The subarachnoid bolt is a small and unobtrusive
device, allowing for a good waveform resolution of
ICP. It is relatively easy to install and is less
invasive than EVD.
However, it does come with several limitations,
including lack of therapeutic uses, unable to be
recalibrated following installation, and the transducer
tip becoming obstructed if it comes into contact with
brain parenchyma, as well as a higher infection risk
and lack of discrimination of infratentorial pressures.
Lidocaine or another local anesthetic will be injected
at the site where the cut will be made. You will most
likely get a sedative to help you relax.

First the area is shaved and cleansed with antiseptic.

After the area is dry, a surgical cut is made. The skin is

pulled back until the skull is seen.

A drill is then used to cut through the bone.

Why the Test is Performed

This test is most often done to measure ICP. It may be done

when there is a severe head injury or brain/nervous system
disease. It also may be done after surgery to remove a tumor or
fix damage to a blood vessel if the surgeon is worried about
brain swelling.

High ICP can be treated by draining CSF through the catheter.

It can also be treated by:

• Changing the ventilator settings for people who are on a

respirator

• Giving certain medicines through a vein (intravenously) 

 Normal & Abnormal Results

Normally, the ICP ranges from 1 to 20 mm Hg.

What Abnormal Results Mean

High ICP means that both nervous system and blood vessel tissues
are under pressure. If not treated, this can lead to permanent damage.
In some cases, it can be life threatening.
 ICP Monitoring Waveforms

The waveforms produced from the ICP monitoring can be used to infer the underlying pathology
present. The wave forms produced are summarised in Table
 
The height order of the wave phases on monitoring should be P1 > P2 > P3. If P2 is highest, this
indicates potential raised ICP
ICP Monitoring Waveforms
Risks

• Bleeding
• Brain herniation or injury from the increased pressure
• Damage to the brain tissue
• Inability to find the ventricle and place catheter
• Infection
• Risks of general anesthesia
After Discharge

• Avoid straining or lifting heavy weights for 1 week.

• No swimming or bathing for 1 week. Showering is
permitted.
• If there are any signs of delayed infection (fever with
temperature over 101, stiff neck, nausea and vomiting,
excessive sleepiness) your provider should be contacted
immediately or report to the nearest emergency room for a
lumbar puncture to evaluate for possible meningitis.
• If you have a severe headache that resolves when you lie
down, you may have a CSF leak. Increase your fluid intake
and avoid straining or heavy lifting. 
• If the positional headache is still present two days after
discharge, let your physician know.
Comfort distressed animals

They can feel disoriented and frightened by the chaos brought by

natural disasters. There are various ways to calm animals and lessen
their anxiety. You may try any of the following methods.
How to comfort animals

Take away the stressor or remove them from the

environment causing them stress. If an animal is out
on the streets looking distressed due to loud
thunder, keep them in a shelter with less noise.

Distract an animal from what's causing them

anxiety. Apart from placing an animal in a calm and
quiet area, you may also give them a toy or some
food to divert their attention.
 In times of environmental events
like bushfires and volcanic eruptions,
it's important to keep the safety
and welfare of animals.
Prepare food and water

Look for any food items left in your fridge that

may be fed to your pets or other animals left
without shelter.
How to 01 Talk to them in a soothing manner and stay closely by
their side. Handle them with care and gentleness
comfort animals especially when you can tell they are feeling anxious
and restless.

02 Note that they may feel disoriented too especially since

disaster can greatly affect their scent markers.

03 Take them to a veterinarian for proper medication when

things have calmed down. It's also important to check if
animals caught any illnesses during the disaster so they
can be treated properly.
Place animals in
a clean environment

Apart from reducing noise Have trash bags and paper

pollution, it's highly
important to provide a clean
space for the animal whether
it's in your own home or an
available location outdoors.
towels ready at all times to
maintain the cleanliness of
their space.
Prepare a carrier

Having a crate or carrier is extremely helpful

during dire times when you need to take an
animal with you.
 Other items you may need

Make sure your pet is wearing a leash or Bring your pet's medical records so
collar with a tag containing important veterinarians know how to care for it in
information like its name, breed, and the best possible way when it gets injured
your contact details. or ill.
Plan your evacuation
01
Know how to bring your animals
with you and where to go. Their
evacuation is equally important
as yours. If it's not safe for you
to stay behind, it's definitely not
safe for them too.
02
Note that animals may not be
allowed to enter some
evacuation centers except for
service animals. Hence, the
importance of planning for their
own logistics.
03
Talk to your local animal
organizations also for the best
course of action. It is wise to
know what your community is
up to in terms of mass
evacuation of animals.
Do your research and
follow instructions from
concerned authorities

Seeking information on how to best care for

different kinds of animals is a must. Listen to the
advice of animal organizations and provide
assistance. This is especially important after a huge
calamities like wildfires or hurricanes where several
animals may be displaced and are in need of care.
Volunteer

During natural disasters, plenty of groups assemble to care for animals

that have been affected. Help when you can and learn how to approach
these animals in the best possible way.