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Life in the Fast Lane • LITFL • Medical Blog

Emergency medicine and critical care medical education blog

Critical Care Compendium | Codman ICP Monitor

Codman ICP Monitor

by Chris Nickson, Last updated July 19, 2014

OVERVIEW

  • intracranial pressure monitor
  • aka ‘bolt’

USES/INDICATIONS

Suspected raised intracranial pressure

  • severe head injury
    — unable to monitor neurologically
    — GCS < 8 and abnormal CT
    — GCS <8 and normal CT with 2/3 of: age >40y, motor posturing and SBP <90 mmHg
  • stroke
  • cerebral edema
  • hydrocephalus
  • hepatic encephalopathy

DESCRIPTION

  • strain gauge tipped catheter or fiberoptic device

 

METHOD OF INSERTION AND/OR USE

  • sterile technique
  • bolt through fronto-parietal suture-line, in line with pupil
  • zero at external auditory meatus
  • penetrates through dura into CSF or intraparencymally
  • held in place by bolt

OTHER INFORMATION

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

ADVANTAGES

  • easy to insert (can be done at bedside)
  • less invasive than EVD
  • more accurate ICP measurements than extradural bolt
  • produces high fidelity wave forms
  • small

DISADVANTAGES/ COMPLICATIONS

  • infection
  • transducer tip may rest on brain and obstruct
  • aspiration of CSF not possible
  • tends to under-read pressures > 20mmHg
  • intracranial transducer cannot be calibrated once in situ
  • baseline drift (especially after 5 days)
  • remember they don’t give an indication of infratentorial pressure
  • no RCT evidence of benefit

References and Links

Journal articles

  • Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, Petroni G, Lujan S, Pridgeon J, Barber J, Machamer J, Chaddock K, Celix JM, Cherner M, Hendrix T. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012 Dec 27;367(26):2471-81. doi: 10.1056/NEJMoa1207363. Epub 2012 Dec 12. PubMed PMID: 23234472; PubMed Central PMCID: PMC3565432.
  • Kirkman MA, Smith M. Intracranial pressure monitoring, cerebral perfusion pressure estimation, and ICP/CPP-guided therapy: a standard of care or optional extra after brain injury? Br J Anaesth. 2014 Jan;112(1):35-46. doi: 10.1093/bja/aet418. Epub 2013 Nov 28. Review. PubMed PMID: 24293327.

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About Chris Nickson

FCICM FACEM BSc(Hons) BHB MBChB MClinEpid(ClinTox) DipPaeds DTM&H GCertClinSim

Chris is an Intensivist at the Alfred ICU in Melbourne and is an Adjunct Clinical Associate Professor at Monash University. He is also the Innovation Lead for the Australian Centre for Health Innovation and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He has a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia's Northern Territory, Perth and Melbourne. He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. He coordinates the Alfred ICU's education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the 'Critically Ill Airway' course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of Lifeinthefastlane.com, the RAGE podcast, the Resuscitology course, and the SMACC conference. His one great achievement is being the father of two amazing children. On Twitter, he is @precordialthump.

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