PLACE LABEL HERE
EVD / ICP MONITORING
(External Ventricular Drain / Intracranial Pressure)
ORDERS
The following orders will be implemented. Orders with a “” are choices are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicatated (multipage).
Select EVD/ICP Device and Treatment Orders
- EVD Orders (Drain Only)
Level EVD to: ____ cm H2O or ____ mmHg above the external auditory canal.
Drain CSF (Choose One)
Continuously
OR INTERMITTENTLY
Open drain every hour and drain ____ mls, then reclamp.
HOB to ≥ 30°
Notify physician if: ______
- Intraventricular Bolt / Flex Catheter(ICP Monitor and Drain)
Level EVD to: ____ cm H2O or ____ mmHg above the external auditory canal
Drain CSF (Choose One)
Continuously
OR INTERMITTENTLY
If ICP > _____ for _____ min, then open EVD drain for ____ min and recheck ICP
Open drain every hour and drain ____ mls, then reclamp.
HOB to ≥ 30°
Decrease stimulation
Insert Arterial Line by RT
Monitor Arterial BP q 1 hr
Monitor ICP q 1 hr
Monitor CPP q 1 hr (CPP = MAP – ICP)
Maintain ICP < ___ mmHg
Maintain PCO2 35-45mmHg
Control body temperature. May use cooling blanket for body temperature > 102°F.
Notify physician if: ______
- Parechymal Bolt (ICP Monitor Only)
HOB to ≥ 30°
Decrease stimulation
Insert Arterial Line by RT
Monitor Arterial BP q 1 hr
Monitor ICP q 1 hr
Monitor CPP q 1 hr (CPP = MAP – ICP)
Maintain ICP < ___ mmHg
Maintain PCO2 35-45 mmHg
Control body temperature. May use cooling blanket for body temperature > 102°F.
Notify physician if: ______
*3-18633*FORM 3-18633 REV. 12/2015 WHITE: Medical Record CANARY: Pharmacy Page 1 of 2
PLACE LABEL HERE
EVD / ICP MONITORING
(External Ventricular Drain / Intracranial Pressure)
ORDERS
The following orders will be implemented. Orders with a “” are choices are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicatated (multipage).
SCHEDULED MEDICATIONS
- Hypertonic/Osmotic Infusion Therapy
Hold for Serum Osmolality greater than ______. Hold for Serum Sodium greater than ______.
Serum Na & Serum Osmolality q __ hrs while on hypertonic/osmotic therapy
Mannitol 20% 0.5 gm/kg IV q ______hr
Mannitol 20% 1 gm/kg IV q ______hr
3% Saline IV ______ml IV bolus q ______hr
3% Saline IV continuous infusion at ______per ml/hr for __ hours
PRN MEDICATIONS
- Hypertonic/OsmoticInfusion Therapy As Needed
Hold for Serum Osmolality greater than ______. Hold for Serum Sodium greater than ______.
Serum Na & Serum Osmolality q __ hrs while on hypertonic/osmotic therapy
Mannitol 20% 0.5 gm/kg IV q ______hr prn if ICP greater than ___ mmHg sustained for 5 min
Mannitol 20% 1 gm/kg IV q ______hr prn if ICP greater than ___ mmHg sustained for 5 min
3% Saline IV ______ml bolus q ______hr prn if ICP greater than ___ mmHg sustained for 5 min
ADDITIONAL ORDERS:
______
______
______
______
______
______
______
Date Time Physician SignaturePID Number
FORM 3-18633 REV. 12/2015 WHITE: Medical Record CANARY: Pharmacy Page 2 of 2