Required monitoring:

• Invasive blood pressure (MAP) until SCPP treatment is discontinued.
• Intrathecal pressure (ITP) via lumbar drain.
• Urine Output: via Foley catheter minimum 48 hours

Physiological Goal: Establish and maintain SCPP > 65 mmHg.

• SCPP = (MAP- ITP)

Methods to achieve goal: Volume expansion, vasopressor support, lumbar CSF drainage.

Nursing Staff:

• Lumbar Drain to be leveled at right atrium, zero transducer every shift.
• Keep lumbar drain closed all times except for CSF drainage.
• Label ITP as ICP on bedside monitor.
• Document MAP, ITP and SCPP hourly, before and after CSF drainage and changes in vasopressor doses
• Drain CSF only when SCPP < 65 mmHg and ITP is > 15 mmHg.
• Maximum hourly drainage = 15 ml

MD/APP Orders: (Cerner CPOE Orders Bold/Italicized)

1. Vital signs: Q 1 hour X 72 hours, then q 2
2. Intake and Output: Q 2hours until Foley removed.
3. Neurological checks: q 2 hours X 72 hours
4. Foley catheter
5. Norepinephrine drip (16 mg/250): Start at 0.1 mics/kg/min, titration goal: SCPP > 65 mmHg.
6. Lumbar Drain
   1. Drain Status: closed.
   2. Drainage amount: up to 15 cc
   3. Frequency: q 1 hour
   4. Keep ITP < 15 mmHg.
   5. Special Instructions: only if SCPP < 65 mmHg.
7. Notify, other
   1. Neurosurgery for: Damped lumbar drain waveform, Lumbar drain not draining or tidaling, change in neurological status or severe headache
8. Communication to Nursing- Continuous:
   1. Document MAP, ITP and SCPP hourly