Instrumentation

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Author:
mbrieger
ID:
93487
Filename:
Instrumentation
Updated:
2011-07-09 20:10:57
Tags:
Ventriculostomy
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Description:
Instrumentation
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  1. Most common insertion sites of ventricular catheters
    • 1. occipital-parietal region - CSF Shunt
    • 2. keen's point - posterior parietal - placement in trigone
    • 3. Dandy's point - may damage visual pathway
    • 4. Kochers point - coronal - ICP monitors - placement in frontal horn
  2. Ventriculostomy is also known as
    • intraventricular catheter (IVC)
    • external ventricular drainage (EVD)
  3. Ventriculostomy insertion
    1. preferred side of insertion
    1. right or non-dominant side
  4. Ventriculostomy set up
    • Clip hair at planed incision site
    • Five minute betadine prep
    • Approximate Kocher's point
  5. Ventriculostomy approximation of kochers point
    • 1 to 2 cm anterior to coronal suture
    • 2-3 cm lateral to midline
  6. Ventriculostomy after kochers point has been located and marked
    • 1. Incision oriented in sagittal plane
    • 2. Elevate periosteum
    • 3. Place self retaining retractor
    • 4. Make twist drill hole
    • 5. Bone wax bone
    • 6. Incise dura in cruciate fashion with #11 scalpel blade
    • Cauterize dural edges with bipolar
    • Insert catheter perpendicular to brain surface to 5 to 7 cm
    • CSF will flow at 3 to 4 cm with ventricular enlargement.
    • If unsuccessful after 3 attempts place a subarachnoid bolt or intraparenchymal monitor

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