Mindray PM-9000, Operation Manual

Page: 255 / 378

IBP Monitoring
15-21
The dura mater should be carefully stripped at least 2cm under the skull and 180° in
arc before insertion. Failure to do this will result in wedging of the pressure sensor
and inaccurate readings. Reseat the transducer tip after a few days since the dura
may rapidly tighten and change its physical characteristics.
If possible, round the bone at the point where the catheter makes its first bend into
the burr hole and round the bone where the catheter makes the second bend under
the cranium. This helps to prevent from tearing the catheter or tip during insertion or
removal. In case of a tear of the catheter, the catheter must be returned to the
manufacturer for repair, incurring a lot of inconveniences.
The catheter is led out through the wound through a drain. It may make sharp bends
without disturbing the operation of the ICT/B. Care should be taken though, to avoid
pinching the catheter by bending onto itself at acute angles for this will seal and
possibly damage the internal lumens required for proper operation.
The catheter should be restrained from moving once the tip is in place. It may be
fixed to the scalp by encircling sutures or with a silicone rubber suture collar
provided by the manufacturer, such as the peritoneal shunt systems. The latter
method is preferred, as it will help prevent from damage to the catheter by sutures or
during removal of sutures.
„ Method 2
First send the catheter to the burr hole through a tunnel under the skin (a small
incision is made on the skin, and the catheter enters the tunnel from a point distal to
the burr hole). The ICT/B can be guided in the tunnel by a disposable tube, which
can be removed afterwards from the burr hole. This method is preferred from both a
mechanical stability point of view and from the low incidence of infection. The
catheter can later be removed in the manner of a drain and the burr hole incision
sutured.
The physician is urged to examine the ICT/B for physical damage to the silicone
rubber covering anywhere on the tip or catheter before use. In case of any damage,
do not use the catheter and return it to the manufacturer for repair. Proper function
should be verified before insertion into the epidural space, by gently touching the tip
of the transducer and observing a pressure change displayed the monitor. Once the
ICT/B has been inserted into the epidural space, the physician should check the
proper function again, by injecting 0.3cc air for zeroing of the ICT/B. The monitor
should respond correctly as described above.