Cerebral Microdialysis in the NSICU
Kristen Fisher, DNP, APN, AGACCNS-BC, CCRN-K, Valerie Musolf, DNP, RN, CCRN, CNRN, Sayona John, MD, FNCS, FAAN, Heather Guth-West, MSN, RN, CCRN, CNL, Stephanie Yohannan, DNP, MBA, RN, NE-BC, CCRN
The Neuroscience ICU (NSICU) became the first hospital in Illinois to utilize cerebral microdialysis (CMD) in October 2019. The advanced technology allows clinicians to get a more detailed clinical picture of complex, critically ill patients with subarachnoid hemorrhage in the brain.
While it is not a treatment, CMD can benefit patients by giving clinicians more data than can be acquired through standard labs and testing. Ongoing analysis of the data allows providers to create a very individualized plan of care to prevent secondary injuries associated with brain hemorrhages.
CMD is a collaborative partnership between nursing, the neurointensivists, fellows, NSICU APPs, residents, pharmacy, and neurosurgery. Each care team member plays a vital role in the implementation and interpretation of the technology.
Potential patients are identified by the NSICU team, and careful consideration of the patient’s status determines whether they would be a good candidate for the technology. Neurosurgery is responsible for placing the intracranial bolt and microdialysis catheter into the brain parenchyma.
Specially-trained NSICU nurses care for the patients with a 1:1 ratio, and obtain and run patient samples every hour for several days. The interdisciplinary team, led by the neurointensivist, reviews the lab values and plan of care each day during rounds.
The values obtained through CMD are reflective of microcellular changes occurring in the brain. Thus, the patient’s CMD values may change before clinicians would see anything during a clinical exam .
Analysis of the lab values prompts a discussion on potential interventions that may best benefit the patient, allowing for interventions to be implemented earlier and targeted directly at the specific needs of the patient.
CMD is particularly beneficial for patients who are comatose, since clinicians are unable to get a good neurological exam and pick up on subtle exam changes. The NSICU is hoping to expand the use of CMD, and is excited to learn more about what the technology can do for the critically ill neuroscience population.