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4. Slit ventricles or intracranial debris in the catheter will dampen or eliminate the pressure wave. Flush the catheter with 1cc of preservative free saline to dislodge debris.

5. The catheter may have become dislodged. Obtain a CT scan to evaluate placement and withdraw tubing if necessary.

Error in ICP Reading

1. Rezero the system.

2. Cross check the pressure reading on the monitor with the pressure indicated by the fluid-filled manometer.

3. Check for air in the system- this will tend to dampen the ICP waveform, although it should not alter the mean ICP.

4. Obtain a CT scan to rule out catheter dislodgment or other error.

Infection

Infection is the primary complication with ventriculostomies. In studies performed on patients, the average infection rate has varied from 0% to 27%. No correlation has been found in prospective studies between the risk of infection and the use of prophylactic antibiotics, or with performing the procedure outside an operating-room setting. Factors correlated with an increased risk of infection are:

1. Intraventricular hemorrhage.

2. Catheterization for longer than 5 days. Some series report no correlation between the duration of monitoring and infection, although it is probably safest to remove the catheter at the earliest possible time.

3. Increased ICP above 20 mm Hg.

4. Tunneling the tubing further from the insertion point has been noted by some to decrease the risk of infection.

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