Intracranial pressure (ICP) monitoring

What is intracranial pressure (ICP) monitoring?

Intracranial pressure (ICP) monitoring is a diagnostic neurosurgical procedure which is used to measures the pressure in someone’s head.

A catheter (tube) is put through a small hole in the skull and into the outer layer of the brain. The catheter is connected to a monitor, which records the intracranial pressure during someone’s hospital stay. This procedure is done under general anaesthetic.

Why does my child need ICP monitoring?

The neurosurgical team want to use ICP monitoring for your child to see if the pressure within their head is high, low or within the normal range. This may be because they have a condition that is linked to abnormal ICP (such as hydrocephalus or a chiari malformation) and are showing symptoms of abnormal ICP. It will help the team to understand if any further neurosurgical treatment is required.

The reason why your child needs ICP monitoring will be fully explained to you by the neurosurgical team.

What happens before surgery?

You will be invited to bring your child to pre-op assessment clinic where doctors and nurses from the neurosurgical team will explain the procedure in detail. This is a good opportunity to ask question and discuss any worries you have about ICP monitoring. If you are happy for the procedure to go ahead, you will be then asked to sign a consent form.

The pre-op team will also make sure your child is well enough to have surgery. They will ask about their medical history, current medication and take your child’s observations, for example, blood pressure, heart rate and temperature. A blood sample may be needed at this appointment.

Are there any risks?

ICP monitoring is considered to be a low risk procedure that provides good information for understanding symptoms and planning treatment. However, as with all surgical procedures, there are potential complications. They include infection and bleeding. The risks will be discussed with you before you are asked to sign the consent form.

What happens on the day of surgery?

You will receive an appointment letter with a date for surgery and the time you need to bring your child to the ward. The letter will give instructions on what to bring with you for your child’s stay, and when you need to stop giving them food and drinks before the surgery. If you are unsure about when you can feed your child before the procedure, please ring the ward for advice before the day of surgery.

When you arrive on Ward 5, a member of the nursing team will show you around the ward and prepare your child is ready for surgery. Your child will be given an identification band and asked to wear a theatre gown. When it is time for surgery, they will be collected from the ward by the theatre team and transferred to the anaesthetic room. One parent or carer is usually invited to go with them and be there as they fall asleep.

Once asleep, you will be given instructions on where and when you can meet your child after the surgery is over. Even though the procedure itself is short, it is likely to be 2 to 3 hours before your child will return to the ward. This is because they will need time to wake up from the general anaesthetic and be monitored closely by the theatre and post op care team.

What happens during ICP monitoring?

When your child returns to the ward, the catheter will be connected to the bedside monitor and ICP monitoring will begin.

The nursing team will carry out regular observation checks (including blood pressure, temperature and heart rate) as they recover from the surgery. Your child will be given food and drink when the nursing team assess that they are fully awake and it is safe to do so. Children can sometimes experiences headaches and discomfort around the surgical wound where the catheter is passed. The catheter is secured in place with sutures (stitches) when your child is still asleep. Local anaesthetic is used around wound in theatre, but once this wears off, regular pain relief can be given on the ward.

Once fully recovered from surgery and whilst connected to the monitor, your child will be encouraged to continue with normal daily activities where possible. This is so we can see what their ICP readings are during various positions and activities.

Discharge home

The monitoring will continue until the neurosurgical team feel they have enough information to decide the best management plan for you child. It is usually 24 to 28 hours, but can be longer.

At this point the ICP catheter will be removed on the ward and the wound closed with a stitch (suture). This usually only takes a few minutes, but sedation can be given if needed. The medical or nursing team will discuss this with you to decide the best option for your child.

After the catheter is removed, your child will be monitored for around 3 hours to make sure that there is no leaking from the wound. If sedation has been given, they will need to fully recover from this too before discharge.

Once the nursing and medical team are happy your child is well enough for discharge, you will be given instructions on how to best care for your child at home .This will include wound care advice, when to give any prescribed medication, when they can return to school or nursery and when they next need to be seen in clinic.

When will we get the results?

The neurosurgeon will discuss the results with you once the readings have been downloaded and analysed. Sometimes this is whilst they are still an inpatient, but usually it is during a clinic appointment a few weeks after discharge.

What if my child is not well?

You should contact the ward if:

• your child becomes drowsy or confused
• your child develops a temperature within a few days of discharge
• the wound site looks red or inflamed and feels hotter than the surrounding skin
• there is any oozing from the wound