Brain Tissue Oxygen Monitoring Device Insertion, Assisting
Brain tissue oxygen (PbtO2) monitoring measures oxygen delivery to cerebral tissue. (See “Brain tissue oxygen monitoring and care,” page 88.) To allow for monitoring of PbtO2, the doctor tunnels a PbtO2 probe under the patient’s scalp using a probe guide
and trocar. Alternatively, he may insert the probe through an intracranial bolt that he then inserts through a burr hole. When used with an intracranial bolt, the system measures PbtO2, brain tissue temperature, and intracranial pressure (ICP).
and trocar. Alternatively, he may insert the probe through an intracranial bolt that he then inserts through a burr hole. When used with an intracranial bolt, the system measures PbtO2, brain tissue temperature, and intracranial pressure (ICP).
The doctor determines the insertion method and placement location after studying a computed tomography (CT) scan of the patient’s brain and considering the patient’s diagnosis. Normal values for PbtO2 range from 20 to 35 mm Hg. (See Brain tissue oxygen monitoring systems.)
Equipment
Sterile gloves, gowns, and drapes ▪ goggles, face masks, and hair caps ▪ antiseptic solution ▪ PbtO2 monitor ▪ connecting cables from the monitor to the patient ▪ cranial access tray ▪ PbtO2 probe ▪ 4″ × 4″ gauze ▪ tape ▪ sterile dry gauze ▪ intracranial bolt system ▪ central line dressing change kit ▪ sterile occlusive dressing ▪ clippers ▪ #11 scalpel blade.
Preparation of Equipment
Gather the PbtO2 monitor and plug it into AC wall outlet. Next, attach the cables to the PbtO2 monitor. Some monitors and cables are color-coded.
Implementation
Verify the doctor’s orders.
Make sure that informed consent has been obtained and is documented in the patient’s medical record.1
Conduct a preprocedure verification to make sure that all relevant documentation, related information, and equipment are available and correctly identified to the patient’s identifiers.2,3,4
Verify that the laboratory and imaging studies have been completed, as ordered, and that the results are in the patient’s medical record. Notify the doctor of any unexpected results.
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.8
Make sure that the patient and his family understand the procedure. Answer any questions to evaluate their understanding of the information provided.
Administer analgesia, sedation, or both as ordered before beginning the insertion procedure to facilitate the insertion process.
Prepare the equipment, being careful not to contaminate the sterile field. Label all medications, medication containers, and other solutions on and off the sterile field while maintaining sterility of the sterile field.9
Elevate the head of the bed to 30 to 45 degrees and place the patient’s head in the neutral position. This position helps decrease ICP by promoting jugular venous outflow, which provides for optimal insertion accessibility.10
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