STANDARD OPERATING PROCEDURES (SOP)

INTRACRANIAL PRESSURE (ICP)

Dosen Pengampu:
Sugesti Aliftitah, S.Kep.,Ns. M. Kep

Oleh:
Aniz Zakina 716.6.2.0716
Astri Krisdiyana 716.6.2.0734
Chairus Sholihah 716.6.2.0729
Misnawati 716.6.2.0752
Triyana Novia Putri 716.6.2.0736
Syaiful Jamil 716.6.2.0742
Ning Elok Izzah A 716.6.2.0747
Februandi Roby Akbar 716.6.2.0722

PROGRAM STUDI KEPERAWATAN

FAKULTAS KESEHATAN
UNIVERSITAS WIRARAJA
2019
A. Understanding of ICT
Intracranial pressure is the value of pressure in the head cavity. This pressure
is inside the skull bone, which means it includes brain tissue, cerebrospinal fluid
and brain blood vessels. At certain pressures, intracranial pressure can increase.
And this is a condition that should not be underestimated.
Increased intracranial pressure and not being treated immediately, can cause
serious to life-threatening conditions. Increased intracranial pressure can not only
occur in adults, but also in infants and children.
B. The purpose
1. To monitor intracranial pressure.
2. CSS collection for culture and laboratory specimens.
3. CSS retrieval to control and reduce intracranial pressure.
C. Indication
Head injury, intracerebral hematoma, subanacroid hemorrhage, central
nervous system infection, cerebral edema, and hydrocephalus.
D. Counter indication
General coagulation abnormalities and cerebral edema resulting in
compression of the ventricles.
E. Preparation of tools
1. Shaving
2. Scrubbetadine brush or sponge face with povidone iodine solution
3. Syringes 5 to 10 cc and with different size needles for injection
4. IV bag that is connected to the fourth bed
5. Pressure modules and monitors
6. Stopcock
7. Transducer
8. 30.5 cm hose
9. 1 bottle of non-bacteriostatic normal saline
10. 10ml syringe with 18G needle to take SN
11. Luer-lok
 12. Betadine ointment, sterile eye shields and 8 cm plaster for dressing over the
insertion site
13. Intraventricular catheter and external drainage system
14. ICT insertion trolleys include:
a. Iodine bowl
b. Screw drill
c. Needle holder
d. Scissors are blunt and sharp
e. Grip of knife and scalpel
f. 4 x 4 sponges
g. Ventricular needles 16 and 18 G
h. 10 ml syringe
F. Working Stage
1. Contents of 10ml syringe with sterile nonbacteriostatic SN for injection.
2. Connect the open end of the procedure to the stopcock hole.
3. Connect the 12-inch pressure hose to the other side of the stopcock hole.
4. Turn off the stopcock to the transducer and rinse the pressure hose.
5. Turn off the hose stopcock into the pressure hose and rinse the transducer, run
the stopcock onto the transducer and hose.
6. Remove the syringe and attach the Luer-Lok to the open end of the stopcock.
Aseptic techniques must be used when installing and rinsing the system. Never
use a transducer with a rinse system.
7. Connect the transducer to the pressure cable. Pressure cables must be connected
to the pressure module on the monitor.
8. Plaster the transducer onto a towel roll to maintain the position of the
transducer at the right height.
9. Raise the head of the bed. The neck must be kept in a neutral position. Place a
protective barrier under the head.
10. The doctor will shave the hair around the insertion and apply betadine or
sponge soaked with povidone iodine solution in the solution. Doctors must use
 sterile masks and gloves. Depending on the patient's condition and the urgency
of the situation, lidocaine can be injected to anesthetize the insertion site. Using
a screw drill, a hole drill can be made anterior to the coronal suture. A catheter
with a guide wire is inserted, directed to the inner eye canthus. Guide wire is
withdrawn, using an aseptic technique, the end of the external drainage storage
system is connected to the catheter through a hole or valve. Connect the
pressure hose from the transducer to the other end of the hole. The distal end of
the catheter is sutured to the scalp.
11. Note the opening pressure.
12. Maintain the transducer at the Monro foramen level.
13. Apply betadine ointment (according to the doctor's instructions) above the
insertion site. Cover the insertion place with sterile eye shield or gauze and the
shield plaster or gauze in place.
14. Using the straps available, support the external drainage system of the IV
hanger installed in the bed. The droplet space is usually 10 to 20 cm above the
height of the Monro foramen.
15. CSS must be streamed intermittently or continuously in accordance with the
provisions. With intermittent drainage, the drainage system is turned on when
the intra-cranial pressure reaches a certain level. Doctors usually program CSS
drainage when intra-cranial pressure is 20 mmHg or more.
16. This system must be turned off in the direction of drainage when the intra-
cranial pressure reading has been obtained for documentation. The pressure
released towards the reservoir system and away from the transducer can cause
artificial low intra-cranial pressure.