Codman ICP Monitor (�bolt�)

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					Codman ICP Monitor (‘bolt’)


26/11/10



USES/INDICATIONS

- severe head injury (GCS < 8 and abnormal CT)
- coma on unknown cause
- liver failure



DESCRIPTION




- strain gauge tipped catheter




METHOD OF INSERTION AND/OR USE

- sterile technique
- bolt through fronto-parietal suture-line, in line with pupil


                                                                 Jeremy Fernando (2010)
- zero at external auditory meatus
- penetrates through dura into CSF or intraparencymally
- held in place by bolt



OTHER INFORMATION


Advantages

-   easy to insert (can be done at bedside)
-   less invasive
-   more accurate than extradural bolt
-   produce high fidelity wave forms
-   small


Interpretation of Waveforms


High amplitude of 50-100mmHg sustained for 15 min (‘A waves’) – raised ICP

Saw tooth with small changes in pressure every 0.5-2 minutes (‘B waves’) – poor intracranial
compliance

Low amplitude oscillations up to 20mmHg for 1 min (‘C waves’) – normal

Flat ICP trace – compression or kinking of transducer

Rounded appearance of the waveform – raised ICP


COMPLICATIONS

-   infection
-   transducer tip may rest on brain and obstruct
-   aspiration of CSF not possible
-   tends to under read pressures > 20mmHg
-   intracranial transducer can be calibrated once in situ
-   baseline drift after 5 days
-   remember they don’t give an indication of intratentorial pressure




                                                                        Jeremy Fernando (2010)

				
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