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Intraventricular haemorrhage and subsequent brain death

Karen Tapp



Abstract

Karen Tapp is a Clinical Nurse Specialist, in the Intensive Therapy Unit at St. Vincent's Hospital, Sydney.

This is a case study of Mr. Jamieson, a 57 year old man who sustained a massive intraventricular haemorrhage in circumstances unknown.

The anatomy and physiology is described in relation to an intraventricular haemorrhage and the nursing care of the unconscious head injured patient in the Intensive Therapy Unit (ITU) is examined. This includes the use and management of intraventricular drains and the implication of a diagnosis of brain death.

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Admission

Missionbeat brought Mr. Jamieson (pseudonym) to the Accident and Emergency Department of St. Vincent's Hospital at 2120 hours on the 29 May 1992. On arrival he was unkempt and covered with vomit and faeces.

He had a patent airway despite a decreased level of consciousness (L.O.C.) and a spontaneous respiratory rate of 12 breaths/minute. A gag and cough reflex were present. Air entry was poor, though equal to both lungs. A large amount of crepitus could be heard over the region between the 8th and 12th rib on the right (R) side, suggesting fractures. His pulse rate was bradycardic, 50/minute and regular. A blood pressure (BP) of 110/80 mmHg was recorded. Due to exposure, Mr. Jamieson was hypothermic with a core body temperature of 34.4°C.

Neurologically, Mr. Jamieson exhibited signs and symptoms consistent with those of a cerebral insult and increased intracranial pressure (I.C.P.). This was determined by the Glasgow Coma Scale (G.C.S.), an internationally recognised tool used to assess changes in level of consciousness. Mr. Jamieson showed nonpurposeful movement with his (R) upper limb only, in response to painful stimuli. He made no verbal response and did not open his eyes. His pupils were small and reacting equally to light. He scored 6 points of a maximum 15 points on the G.C.S.

A laceration and swelling were noted over the occiput. A large bruise covered the (R) hip and multiple small grazes were over both knees and shins. At the time of admission, blood results of significance were potassium 3.3 mmol/L and blood alcohol of 0.36%.

At 2300 hours on 29 May 1992, it was recorded that Mr. Jamieson had deteriorated neurologically. His pupils were mid-sized and not reacting to light. This suggested that neither parasympathetic nor sympathetic innervation were operational (Hickey 1986: 128). An urgent Computerized Tomography (C.T.) scan was attended at 2345 hours.

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Cerebral Computerised Tomography

C.T. scanning allows highly accurate diagnosis of neurological conditions by computer analysis of horizontal cross sections of the brain (Holloway 1988: 76).

Mr. Jamieson's C.T. scan revealed a large intraventricular haemorrhage completely filling the 4th ventricle, cerebral aqueduct, 3rd ventricle and occipital horns of both lateral ventricles. A blood clot was adherent to both choroid plexuses in the lateral ventricles. Raised intracranial pressure (ICP) and obstructive hydrocephalus were demonstrated by dilatation of the entire ventricular system and effacement of cerebral sulci. Subarachnoid blood was within the left (L) Sylvian fissure and obliterating the basal cisterns. No midline shift and no extra axial collections were observed. Linear fractures through the (R) occipital bone, internal occipital protuberance and mid occiput, and a transverse fracture through the (L) petrous temporal bone were visible.

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Anatomy and Physiology

The ventricular system of the brain consists of four (4) irregularly shaped interconnected spaces for the production and circulation of cerebrospinal fluid (CSF). There are two lateral ventricles, one in each cerebral hemisphere, extending into each lobe. These contain the major part of the choroid plexus which produces CSF. The third ventricle is posterior to the hypothalamus and the fourth ventricle sits in the brain stem, posterior to the pons. CSF flows throughout these chambers and then via the foramen of Magendie into the subarachnoid space. It bathes the spinal cord and flows over the surface of the cerebral hemispheres to the superior sagittal sinus, where it is reabsorbed.

The rate of CSF production is normally equal to the rate of its absorption (Tortora 1981: 330). However following a cerebral haemorrhage, the arachnoid villi, the small channels that the CSF is absorbed through, can become seriously blocked. This is due to the sudden appearance of large numbers of cells in the CSF (Guyton 1991: 376). Consequently there is an accumulation of fluid within the ventricles of the brain known as hydrocephalus internal (Taber 1981: 676). This increases the intracranial pressure.

The intracranial volume is contained in a tightly closed space. Therefore, an increase of any labile element of its contents - nervous tissue, blood volume, CSF - can take place only at the expense of the other element(s), or by an increase in intracranial pressure (Thompson 1991: 280). Mr Jamieson had increased ICP due to haemorrhage into the CSF compartments.

When all compensatory mechanisms of the brain fail in response to increased ICP, brain damage occurs because of tissue ischaemia and compression (Luckman & Sorenson, 1982: 541). The compression of Mr. Jamieson's brain caused irreversible, ischaemic damage.

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Medical Management

The medical management and nursing care of Mr. Jamieson which follows, aimed to normalise ICP and prevent any further neurological damage occurring.

Mr. Jamieson's condition deteriorated rapidly during the C.T. scan. He was unable to maintain a clear airway, so oral intubation was performed and ventilatory support commenced. Following C.T. scan, he was transferred to the operating theatre for the insertion of an intraventricular drain (I.V.D.). A catheter was passed into the lateral ventricle via a right frontal burr hole to drain C.S.F. and blood from the ventricular system and thus reduce intracranial volume (Sinclair 1992: 21).

Mr. Jamieson arrived in ITU, hypothermic and hypotensive. His haemoglobin (Hb) level was 6.6 g/dl. A blood transfusion totalling six (6) units of packed cells aimed to replace blood loss to maximise tissue oxygen (O2) delivered, by raising available haemoglobin (Skowronski 1990: 373). The post transfusion Hb was 12.8 g/dl, which is within normal limits.

Circulating blood volume was maintained by intravenous colloid and crystalloid solutions. The use of metaraminol, an inotropic drug, was not required until Mr. Jamieson's last hours of care in ITU. Mr. Jamieson received no other significant drug therapy in the management of his neurological condition.

Due to the extensive damage visualised on the cerebral C.T. scan, combined with his clinical presentation, Mr. Jamieson's prognosis was considered poor. His medical management and nursing care were primarily supportive.

The aims, actions and rationale for each action of Mr. Jamieson's nursing care, while in ITU is summarised in Table 1 (Appendix).

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Brain Death

Despite the implementation of all appropriate medical and nursing actions, Mr. Jamieson's condition did not improve. In fact, all evidence suggested he was brain dead. Brain death is the irreversible loss of all brainstem function (OH 1990: 294).

Clinical diagnosis can only be made in a patient who is normothermic, normotensive, free of neuromuscular blocking agents, with normal metabolic and biochemical blood levels (Pearson, 1990: 1).

At 1000 hours on 31 May 1992 these conditions were present in Mr. Jamieson. The following neurological tests and responses were recorded in order to diagnose brain death:

On the 1 June 1992, the same neurological tests were repeated and all tests concluded that Mr. Jamieson had suffered brain death. A cerebral angiogram was conducted to confirm this. The absence of cerebral blood flow is presently considered the most reliable ancillary test in diagnosing brain death (Alvarez et al. 1988: 225). This proved to be the case with Mr. Jamieson.

The possibility of organ donation was discussed. However, in the absence of any traceable relative, permission for organ donation was required from the Clinical Superintendent of St. Vincent's Hospital and the Coroner. In view of a potential criminal act underlying the situation, permission for organ donation was denied by the State Coroner.

Ventilation was ceased at 1800 hours and Mr. Jamieson died soon after.

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Psychosocial Implications

Hospitalisation causes psychological and social stress on a patient and his significant others. Those persons who play key roles in a patient's life are significant others (Holloway 1988: 36). Mr. Jamieson had no family and his closest significant friend was his employer. Responsibility for meeting Mr. Jamieson's needs was met by the nurses who cared for him.

Although Mr. Jamieson was unconscious, all nursing staff introduced themselves. They continually orientated him to his surroundings and explained all procedures performed. Unnecessary stimuli were reduced and a pleasant auditory environment was created by soft playing of music at night.

Mr. Jamieson was not left unattended and raised bed rails provided safety at all times.

Nursing staff liaised with the social worker assigned to investigate Mr. Jamieson's specific social circumstances.

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Patient Outcome

As the cause of Mr Jamieson's injuries remained undetermined, the body of Mr. Jamieson was transferred to the City Coroners' Court Glebe and an autopsy was performed in accordance with legal requirements. The results of the investigations were not available at the time of writing this case study.

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Conclusion

Mr. Jamieson's case history illustrates that the consequence of a massive intraventricular haemorrhage is raised I.C.P., which leads to cerebral compression and ischaemia. An intraventricular drain may be inserted to reduce CSF volume and thus I.C.P. However in the case of Mr. Jamieson, brain damage from such abnormal physiology was irreversible and resulted in brain death.

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References

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Appendix

Table One. Nursing Care Plan

GOAL NURSING ACTION RATIONALE MR JAMIESON'S CASE
  • Maintain a patent airway.
  • Regular suctioning of endotracheal tube (ETT).
  • Confirm correct position of ETT on X-ray.
  • Secure ETT firmly.
  • Ensure ETT cuff is adequately inflated.
  • Listen for air entry to both lungs.
  • Priority of all care is maintaining an airway.
  • Secretions or sputum leads to obstruction.
  • Malposition or dislodgement leads to anatomical damage.
  • Deflated cuff increases risk of aspiration and ineffective ventilation.
  • If airway is obstructed decreases in air entry.
  • Mr Jamieson's ETT was correctly positioned and well secured. No complications developed from the cuff.
  • Air entry was equal and good to both lungs.
  • Effective artificial ventilation
  • Record oxygen saturation hourly.
  • Titrate inspired oxygen concentration (F1O2) hourly
  • Record capnometer hourly and alter respiratory rate/tidal volume accordingly..
  • Regular arterial blood gases (ABG).
  • Early detection and correction of faults in equipment or changes in patient's condition.
  • Pulse oximetry is a non-invasive method of measuring O2 saturation of functional haemoglobin (Galvin 1992: 1).
  • A capnometer measures end tidal carbon dioxide (CO2) non invasively.
  • Hyperventilation, CO2 is decreased causing cerebral vasoconstriction therefore decreased cerebral blood flow means decreased ICP (Thompson 1992: 284).
  • ABGs are an accurate measure of effectiveness of ventilation
  • Respiratory observations were recorded hourly.
  • 02 saturation remained >90% when F1O2 was titrated between 30-50%.
  • Mr. Jamieson's CO2 limits were 30-35mmHg. To maintain this his respiratory rate increased from 10-12 breath/minute and tidal volume from 800mls to 50mls to 900mls per breath.
  • Mr Jamieson's ABG's confirmed the readings of the capnometer and oximeter.
  • To prevent further chest trauma and infection
  • Special care with 2nd hourly position changes
  • Check daily X-ray for any change in position of fractures or signs of infection.
  • 2nd hourly hand ventilation.
  • Position changes prevents pooling of lung secretions (Brunner, L. & Suddarth. 1982: 721)
  • Gentle hyperinflation loosens secretions.
  • 2nd hourly position changes are attended.
  • No changes were seen on X-ray.
  • Minimal secretions on suctioning.
  • Maintain circulating blood volume
  • Record pulse and blood pressure (BP) hourly
  • Record central venous pressure (CVP) 4th hourly.
  • Administer intravenous fluids as ordered.
  • Record amount and type of fluid given.
  • Tachycardia and decreased BP precede hypovoleamic shock (Skowronski 1990: 372).
  • CVP reflects venous return to the (R) atrium decrease CVP from true hypovolaemia (fluid loss) or relative hypovolaemia (vasodilation) (Holloway 1988: 251).
  • Fluid given should match fluid lost (Skowronski 1990: 372).
  • Strict control of fluid balance helps control cerebral oedema (Thompson 1990: 430).
  • Post operatively CVP was 2.5cm H2O and increased pulse and decreased BP.
  • The trend continued to be normal but low, reflecting medical management to keep the circulating blood volume restricted.
  • Mr Jamieson received plasma expanders to increase blood volume.
  • An accurate fluid balance chart was recorded.
  • Early detection and treatment of changes in neurological status.
  • Record Glasgow Coma Scale hourly (GCS).
  • Report any changes immediately.
  • A scale used to grade severity and outcome of traumatic head injury (Frisby 1990: 261).
  • Examines eye opening, motor and verval response.
  • Maximum score 15.
  • Minimum score 3.
  • Mr Jamieson's GCS was 6 on admission and within 4 hours it decreased to 3. At no time were there any signs of improvement noted. His injury was severe and outcome poor.
  • Correct management of ventricular drain.
  • Record hourly colour and volume from ventricular drain.
  • Ensure drain is positioned 15cm above external auditory meatus.
  • Check patency of drain and integrity of system.
  • Sterile technique for dressings and emptying bag. Minimise handling.
  • Position head of patient at 30 degrees.
  • Correct positioning prevents CSF draining too quickly, causing ventricular collapse or tentorial herniation (Sinclair 1991: 21).
  • Blockage leads to no drainage leads to increased ICP.
  • Drain provides a direct route for infection.
  • Facilitate venous return, decreased jugular venous pressure and decreased ICP (Brunner & Suddarth, 1982: 712).
  • On average Mr Jamieson's hourly ventricular drainage was 10-15 mls. Blood stained. Mr Jamieson was nursed with his head at 30 degrees.
  • Correct management of skull fractures.
  • Observe orifices for leaking CSF, ie rhinorrhea or otorrhea. Tape sterile pads under nose or against ear to collect drainage.
  • A transverse fracture through the temporal petrous bone may result in a dural tear and leakage of CSF, and the dura adheres closely to this bone (Holloway 1988: 534).
  • On day 3, Mr Jamieson developed rhinorrhea and otorrhea but it was inconclusive as to whether it contained CSF.
  • Sterile pads were placed in each ear and under his nostrils.
  • Maintain electrolyte balance.
  • Carry out serial blood and urine electrolyte and osmolality studies.
  • Head injuries may be accompanied by disorders of sodium retention, water retention and a decrease in sodium potassium levels (Brunner and Suddarth, 1982: 713).
  • Mr Jamieson's sodium did not become significantly raised. His potassium was significantly low on admission and supplements were given intravenously.
  • Maintain fluid balance.
  • Record hourly output via an indwelling urinary catheter.
  • Daily urinalysis.
  • Test specific gravity daily.
  • Indicates adequacy of organ perfusion.
  • Indicates signs of infection or trauma.
  • Diabetes insipidus as a possible complication of brain injury (Vedig 1990: 332).
  • Urine output remained consistently >1/2 ml/kg and thought at times large, did not suggest diabetes insipidus. Urinalysis on admission tested positive for blood, ketones and protein suggesting trauma or infection.
  • No specific treatment was given.
  • Normothermia.
  • Passively rewarm patient with warm blankets.
  • Record rectal temperature hourly.
  • Observe arrhythmias and electrolyte imbalances.
  • Decreased temperature may be due to external stress or defective central regulation (Aun 1990:467).
  • Rectal temperature represents most accurately the core body temperature.
  • On admission Mr Jamieson's temperature was 33.6°C. His maximum recorded temperature was 37.6°C. With decreased neurological function his thermo regulation centre malfunctioned. His temperature decreased to 34.5°C despite passive rewarming.
  • Care of gastro-intestinal tract (GIT).
  • Insert nasogastric tube.
  • Aspirate nasogastric tube 6th hourly.
  • Administer antacid 6th hourly.
  • Gastric acid hypersecretion is common in patients with head injuries.
  • May result in ulceration and haemorrhage of stomach (Brunner and Suddarth 1982: 713).
  • Mr Jamieson had moderate gastric aspirates of 10-90mls attended 6th hourly.
  • Care of intravenous (IV) lines.
  • Record site and date of insertion.
  • Check site each shift for sign of infection.
  • Check position of central line on X-ray.
  • Aseptic technique for all handling and dressings is imperative.
  • IV sites provide direct route of access to the blood stream for infection.
  • Correct position of central line to prevent arrythmias, for correct administration of drugs and fluids. For accurate CVP readings.
  • Mr Jamieson did not develop infection. His central line viewed on X-ray was correctly positioned in the superior vena cava.
  • Maintain skin integrity.
  • Position change every 2 hours.
  • Keep skin clean and dry.
  • Use of pressure relieving device.
  • Constant pressure on skin causes arteriolar pressure that leads to skin necrosis (Holloway 1988: 503).
  • A high risk due to poor physical condition, age and decreased LOC. Strict 2nd hourly pressure care was given.
  • Prevent eye damage.
  • Irrigate eyes with sterile ophthalmic ointment 2nd hourly.
  • Inspect condition of eyes with flashlight.
  • If eyes are allowed to dry they become glazed and corneal ulceration occurs.
  • Mr Jamieson's were cleaned with sterile sodium chloride solution and sterile lubricant applied.
  • Maintain integrity of oral cavity.
  • Brush teeth with a toothbrush.
  • 2nd hourly mouth rinsing and suction.
  • Moisturise lips.
  • Foam pads under ETT tapes.
  • ETT prevents swallowing and increases production of saliva.
  • Lips become dry.
  • Risk pressure areas from ETT.
  • Oral hygiene was maintained.
  • Prevent deep vein thrombosis.
  • Passive limb exercises.
  • Apply anti-embolic stockings.
  • Thrombo emboli result from blood stasis (Holloway 1988:174).
  • Anti-embolic stockings maintain blood flow.
  • Anti-embolic stockings were applied but passive limb exercises were not done due to the severity of Mr Jamieson's head injury.

Table One. Nursing Care Plan

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