Complications of intracranial pressure monitoring

Complications associated with intracranial pressure monitoring include infection, hemorrhage, malfunction, and malposition. The vast majority of these complications are minor and do not produce long-term morbidity. Infection is the most common complication. It usually takes the form of bacterial colonization of the catheter or positive surveillance cultures of cerebrospinal fluid. Grossly purulent ventriculitis is rare. Risk factors for infection include duration of monitoring, associated intracranial injuries, concurrent infection, external irrigation, and serial replacement of monitors. Several groups have reported correlation between the duration of monitoring and the frequency of infection. Others have reported that the chance of infection decreases after the monitor has been in place for 6 days or more, suggesting that the primary source of infection was contamination at the time of insertion. The overall infection rate for intracranial pressure monitors is approximately 5 to 10 per cent. At our institution, ventriculostomy catheters are left in place until neurological improvement has occurred, intracranial pressure is stable and has not required treatment for 24 h, or daily surveillance cerebrospinal fluid studies become suspicious for infection (catheters are reinserted through a new site).

Hemorrhage is associated with insertion of intracranial pressure devices in 1 to 2 per cent of cases. The majority of hemorrhages are small and require no treatment. Significant hematomas which require surgical drainage occur in approximately 0.5 per cent of cases. Disseminated intravascular coagulation, fibrinolysis, anticoagulation, and impaired liver synthetic function increase the risk of hemorrhagic complications. At our institution, all patients are screened with routine laboratory tests to detect coagulation abnormalities prior to insertion of intracranial pressure devices. Extraparenchymal devices have lower risk of hemorrhage.

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