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Letter to Editor in Response to “Zero-Calibrating External Ventricular Drains: Exploring Practice”

Letter to Editor in Response to “Zero-Calibrating External Ventricular Drains: Exploring Practice” LETTER TO THE EDITOR Volume 54 � Number 3 � June 2022 107 Letter to Editor in Response to “Zero-Calibrating External Ventricular Drains: Exploring Practice” Rachel Malloy I was pretty excited when I first read the Pratt et al accuracy of level from the filter at the top of the bu- abstract for “Zero-Calibrating External Ventricular Drains: rette to the zero-pressure reference point. Although Exploring Practice,” particularly when the abstract research does correlate infection with EVD manipu- results section stated, “Bedside trial showed equiva- lation, I ponder whether there is evidence that open- lence when comparing intracranial pressure (ICP) tidal, ing a transducer to air causes increased infection. ICP after EVD zero with NVC removal, and ICP after Furthermore, I wonder, are nurses making decisions EVD zero without NVC removal.” Upon further reading on zeroing a transducer through the filter and poten- the manuscript, I was less enthusiastic as the bedside tially creating an inaccuracy at the baseline zero in re- trial listed in the methods section was a single-subject sponse to an assumed potential for infection? observation with minimal details. I applaud the authors Contrary to the way this letter may sound, I do not for formally starting the conversation by publishing the have a strong opinion about zeroing the transducer reality that there is variance in practice when zeroing one way over the other. My frustration lies with the an external transducer on an external ventricular drain extent of variability around what is arguably the most (EVD). Given the data, I believe a proper clinical trial common diagnostic tool used with the brain-injured needs to be completed and repeated to state which patient. I appreciate that the authors chose a zeroing method for zeroing the transducer on an EVD sup- technique as a clinical practice that best fits their fa- ports evidence-based practice. The differences in man- cility. I believe that nurses ask about zeroing because ufactured medical equipment are a confounder in a they want the best outcomes for their patients. In this study of this type. situation, as the authors indicate, when research evidence Zeroing a transducer is a function of a transducer, does not exist, I believe, until there is evidence to base not a function of an EVD. Pressure transducers must practice, nurses are obligated to have this conversation be zeroed to atmospheric pressure no matter what pres- and choose the best standard for their facility. sure they measure. The question at hand is, “What is the best way to access air when zeroing a transducer attached to an EVD?” When zeroing through the fil- Reference ter on the burette, hypothetically, many factors can 1. Pratt KA, Peacock SH, Yost KD, Freeman WD, Collins CI, affect the accuracy of a zeroed atmospheric pressure. McLaughlin DC. Zero-calibrating external ventricular drains: These factors include the density of the filter over time, exploring practice. J Neurosci Nurs. 2021;54(1):2–5. doi:10. the size of the opening to air on the burette, and the 1097/jnn.0000000000000622 Questions or comments about this article may be directed to Rachel Malloy, MSN, RN, CNRN, SCRN, at Rachel.d.malloy@gmail.com. R.M. is a Clinical Application Manager, Neurocritical Care, Natus, Middleton, WI. Copyright © 2022 American Association of Neuroscience Nurses https://doi.org/10.1097/JNN.0000000000000647 Copyright © 2022 American Association of Neuroscience Nurses. Unauthorized reproduction of this article is prohibited. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Neuroscience Nursing Wolters Kluwer Health

Letter to Editor in Response to “Zero-Calibrating External Ventricular Drains: Exploring Practice”

Journal of Neuroscience Nursing , Volume 54 (3) – Jun 2, 2022

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References (2)

Publisher
Wolters Kluwer Health
Copyright
Copyright © 2022 American Association of Neuroscience Nurses
ISSN
1945-2810
eISSN
0888-0395
DOI
10.1097/jnn.0000000000000647
Publisher site
See Article on Publisher Site

Abstract

LETTER TO THE EDITOR Volume 54 � Number 3 � June 2022 107 Letter to Editor in Response to “Zero-Calibrating External Ventricular Drains: Exploring Practice” Rachel Malloy I was pretty excited when I first read the Pratt et al accuracy of level from the filter at the top of the bu- abstract for “Zero-Calibrating External Ventricular Drains: rette to the zero-pressure reference point. Although Exploring Practice,” particularly when the abstract research does correlate infection with EVD manipu- results section stated, “Bedside trial showed equiva- lation, I ponder whether there is evidence that open- lence when comparing intracranial pressure (ICP) tidal, ing a transducer to air causes increased infection. ICP after EVD zero with NVC removal, and ICP after Furthermore, I wonder, are nurses making decisions EVD zero without NVC removal.” Upon further reading on zeroing a transducer through the filter and poten- the manuscript, I was less enthusiastic as the bedside tially creating an inaccuracy at the baseline zero in re- trial listed in the methods section was a single-subject sponse to an assumed potential for infection? observation with minimal details. I applaud the authors Contrary to the way this letter may sound, I do not for formally starting the conversation by publishing the have a strong opinion about zeroing the transducer reality that there is variance in practice when zeroing one way over the other. My frustration lies with the an external transducer on an external ventricular drain extent of variability around what is arguably the most (EVD). Given the data, I believe a proper clinical trial common diagnostic tool used with the brain-injured needs to be completed and repeated to state which patient. I appreciate that the authors chose a zeroing method for zeroing the transducer on an EVD sup- technique as a clinical practice that best fits their fa- ports evidence-based practice. The differences in man- cility. I believe that nurses ask about zeroing because ufactured medical equipment are a confounder in a they want the best outcomes for their patients. In this study of this type. situation, as the authors indicate, when research evidence Zeroing a transducer is a function of a transducer, does not exist, I believe, until there is evidence to base not a function of an EVD. Pressure transducers must practice, nurses are obligated to have this conversation be zeroed to atmospheric pressure no matter what pres- and choose the best standard for their facility. sure they measure. The question at hand is, “What is the best way to access air when zeroing a transducer attached to an EVD?” When zeroing through the fil- Reference ter on the burette, hypothetically, many factors can 1. Pratt KA, Peacock SH, Yost KD, Freeman WD, Collins CI, affect the accuracy of a zeroed atmospheric pressure. McLaughlin DC. Zero-calibrating external ventricular drains: These factors include the density of the filter over time, exploring practice. J Neurosci Nurs. 2021;54(1):2–5. doi:10. the size of the opening to air on the burette, and the 1097/jnn.0000000000000622 Questions or comments about this article may be directed to Rachel Malloy, MSN, RN, CNRN, SCRN, at Rachel.d.malloy@gmail.com. R.M. is a Clinical Application Manager, Neurocritical Care, Natus, Middleton, WI. Copyright © 2022 American Association of Neuroscience Nurses https://doi.org/10.1097/JNN.0000000000000647 Copyright © 2022 American Association of Neuroscience Nurses. Unauthorized reproduction of this article is prohibited.

Journal

Journal of Neuroscience NursingWolters Kluwer Health

Published: Jun 2, 2022

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