Nursing management of the patient undergoing intracranial pressure monitoring, external ventricular drainage, or lumbar drainage.
Subject: Patient monitoring (Management)
Intracranial pressure
Nursing care
Practice guidelines (Medicine)
Authors: Slazinski, Tess
Anderson, Tracey
Cattell, Elizabeth
Eigsti, Janice E.
Heimsoth, Susan
Holleman, Judith
Johnson, Amanda
King, Mary
Lay, Twyila
Presciutti, Mary
Prior, Robert
Richlik, Brian
Schmelzer, Shawn
Hage, Anna Ver
Wamboldt, Carol
White, Kelly
Zakzewski, Paula L.
Pub Date: 08/01/2011
Publication: Name: Journal of Neuroscience Nursing Publisher: American Association of Neuroscience Nurses Audience: Professional Format: Magazine/Journal Subject: Health care industry Copyright: COPYRIGHT 2011 American Association of Neuroscience Nurses ISSN: 0888-0395
Issue: Date: August, 2011 Source Volume: 43 Source Issue: 4
Topic: Event Code: 200 Management dynamics Computer Subject: Company business management
Accession Number: 263250561
Full Text: ABSTRACT: Nursing care of the patient with an intracranial pressure (ICP) monitoring device, external ventricular drain (EVD), or lumbar drainage device (LDD) is inherently complex. This complexity arises from the meticulous monitoring and multidimensional clinical decision making required for nurses to provide optimal care. This clinical practice guideline takes a life span approach and provides resources and recommendations for practice to enable registered nurses, clinical care units, and institutions to make decisions that will optimize patient outcomes for patients requiring ICP monitoring devices, EVDs, or LDDs. The guideline includes tools that may assist institutions in developing policies and procedures for best practice based on current evidence.


Nursing care of the patient with an ICP monitoring device, EVD, or LDD is inherently complex because patients requiring these interventions require meticulous monitoring and multidimensional clinical decision making. The purpose of this clinical practice guideline was to assist registered nurses, patient care units, and institutions in providing safe and effective care to patients undergoing ICP monitoring via an EVD or those undergoing subarachnoid drainage of cerebrospinal fluid with an LDD. This new clinical practice guideline is based on current evidence and practice standards and replaces two previous American Association of Neuroscience Nursing guidelines: Care of the Patient With Intracranial Pressure Monitoring and Care of the Patient With a Lumbar Drain. In the development of the guideline, nurse experts reviewed the published literature from 2000 to December 2010 using PubMed/ Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature, and the search included the following terms: intracranial pressure monitoring device, intracranial pressure waveform, external ventricular drain, lumbar drain, indwelling catheters, drainage, cerebrospinal fluid, ventriculostomy, and nursing. Monographs and textbooks were also consulted. Studies not written in English were excluded from further evaluation. Data quality was evaluated and recommendations for practice were established based on the evaluation of available evidence and expert panel consensus. The guideline covers issues such as indications for monitoring and device placement, ICP waveform analysis, equipment setup, insertion, maintenance, patient assessment and monitoring, troubleshooting, prevention and management of complications, and patient and family education. The guideline takes a life span approach, addressing both adult and pediatric management. Recommendations for practice and areas requiring further investigation are included. The guideline includes tools that may assist institutions in implementing guideline recommendations. The complete guideline is available as Supplemental Digital Content, at

Tess Slazinski, RN MNC CRN CNRN; Tracey Anderson, MSN CNRN FNP-BC ACNP; Elizabeth Cattell, MN CNRN ACNP-C; Janice E. Eigsti, RN MSN CCRN CNRN; Susan Heimsoth, RN; Judith Holleman, MSN RN CPNP; Amanda Johnson, RN MSN CPNP; Mary King, MSN RN CNRN CCRN; Twyila Lay, MS ACNP-BC; Mary Presciutti, RN BSN CCRN CNRN; Robert Prior, RN CNRN; Brian Richlik, RN BSN CCRN; Shawn Schmelzer, BSN RN CCRN; Anna Ver Hage RN BSN CCRN; Carol Wamboldt, MS CRNP CNRN; Kelly White, RN BSN CCRN CNRN; Paula L. Zakzewski, RN MSN CPNP-AC

DOI: 10.1097/JNN.0b013e3182160725

Questions or comments about this article may be directed to Hilaire Thompson, PhD RN CNRN FAAN, at She is the editor of the AANN Clinical Practice Guideline Series.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (
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