Multi-Modal Neuromonitoring With Measuring Catheters
Reliable Measurement of Important Parameters
NEUROVENT measuring catheter for neurosurgery to measure epidural (1), parenchyma (2), or ventricular (3) pressure.
NEUROVENT measuring catheters are used in the field of neurosurgery. During invasive neurosurgical procedures, the catheter is used to reliably measure the:
- ICP (intracranial pressure)
- ICT (intracranial temperature)
- ptiO2 (oxygen partial pressure)
The multi-modal neuromonitoring performed with the measuring catheter in the field of neurosurgery makes it possible to recognize the causes of cerebral damages early on. If the parameters change, they are safely, quickly, and accurately displayed on the neuromonitor. As a result, the patient can be treated correctly.
Extensive Product Portfolio
NEUROVENT measuring catheters are used to monitor parenchyma, ventricular, and epidural measurements in the brain. The measurement can be performed by connecting the device with a cable or with the help of telemetry. Due to the comprehensive product portfolio of our NEUROVENT catheters, we have the right catheter for every indication and for a variety of treatment methods. Furthermore, a single catheter combines up to three measuring functions: ICP (intracranial pressure), ICT (intracranial temperature), and ptiO2 (oxygen partial pressure).
In addition to the NEUROVENT catheters, our product portfolio for the field of neurosurgery also offers a great number of accessories. These are used to implant the catheters safely, to document and analyse the measured results, and to transfer the measured results to all common patient monitors in neurosurgery.
Advantages of NEUROVENT Catheters
Additional advantages of the neurosurgical measuring catheter made by RAUMEDIC are:
- All-in-one system: one catheter with up to three measuring functions
- Simple and easy handling, because users do not have to calibrate the measuring catheter. It is a plug-and-play system
- Time savings through the direct connection of the catheter to the already present patient monitor and immediate display of the ICP (intracranial pressure) and the temperature
- No catheter explanation required for the imaging process due to MR conditional up to three Tesla
- Accurate and stable measuring quality resulting in appropriate therapy decisions
Measurement of ICP (Intracranial Pressure) in the Brain
Indications of ICP Measurement
The continuous measurement of the ICP (intracranial pressure) is an invasive procedure used to determine the pressure inside the cranium. Due to the limited expansion capabilities of the brain because of the firm cranium, the ICP increases inside the cranium as the volume increases. Therefore, a precise monitoring of the pressure in the inside of the cranium is very important, because the clinical symptoms are initially unspecific. Indications for measuring the ICP are:
- Severe craniocerebral injury
- Significant subarachnoid bleeding
- Intraparenchyma and intraventricular cranial bleedings
- Severe meningitis
- Reye syndrome
- For all polytraumatized patients
- For all coma patients with unknown etiology
ICP Measuring Locations
The ICP (intracranial pressure) can be measured at different locations in the brain.
For measuring ICP in the parenchyma, the NEUROVENT-P catheter measures the pressure directly in the brain tissue.
Various types of ventricular catheters are available for direct measurement of pressure in the ventricles. Due to the additional drainage function of the NEUROVENT catheter, excess CSF (cerebrospinal fluid) is drained from the ventricles. The elevated ICP is also lowered by draining the CSF. Implantation of ventricular catheters is facilitated by various application tools such as a stylet or a guide wire. The NEUROVENT-Sleeve Housing is an unique design which incorporates ICP measurement in the parenchyma and CSF drainage in the ventricle. As an alternative, the NEUROVENT VP 16 is available for neuronavigation using a stylet.
To record the epidural pressure, the NEURODUR catheter is placed directly on the dura. The ICP is measured directly at the elastic dura.
Products for Measurement
NEUROVENT-P: Parenchyma ICP measurement
NEUROVENT: Ventricular ICP measurement with CSF drainage
NEUROVENT-Sleeve Housing: Parenchyma ICP measurement and CSF drainage
NEUROVENT VP 16: For neuronavigation using a stylet
NEURODUR: Epidural ICP measurement
Measurement of Temperature in the Brain
Importance of Temperature Measurement
Aside from monitoring the ICP (intracranial pressure), the measuring of the temperature is a basic parameter used to monitor patients subject to intensive neurosurgical monitoring. The temperature in the brain is different from the body’s core temperature. By measuring the temperature, inflammatory processes and dangerous temperature increases in the brain can be detected early on. In addition, the monitored measurement of the temperature difference between the temperature in the brain and the body provides additional information about the brain’s intact thermoregulation.
Locations Where Temperature is Measured
The temperature function is, in addition to the ICP (intracranial pressure) integrated in many versions of our RAUMEDIC measuring catheter. The temperature can be measured at different locations in the brain.
For the parenchyma temperature measurement, the measuring catheter NEUROVENT-P-TEMP measures the pressure directly in the brain tissue. In addition to the ICP (intracranial pressure), the temperature is measured in the parenchyma.
Our NEUROVENT-TEMP catheter comes in many different versions for measuring the temperature, the ICP (intracranial pressure) and the drainage of the ventricles. Due to the additional drainage function of the ventricular measuring catheter, excess cerebrospinal fluid is drained from the ventricles. This implantation is facilitated by various application tools such as a stylet or guide wire.
The epidural catheter NEURODUR-TEMP is placed for measuring purposes directly on the dura. Also here, the temperature and the ICP (intracranial pressure) are recorded indirectly via the elastic dura.
Measurement of Oxygen Partial Pressure in the Brain
Importance of Measuring Oxygen Partial Pressure
After primary cerebral damage to the brain caused by a traumatic event, there is a high risk of secondary damage to the brain tissue. One of the main causes is cerebral oxygen deficiency. In most patients, the elevated ICP (intracranial pressure) negatively impacts cerebral perfusion and can therefore cause cerebral ischemia. This temporary or permanent disproportion between the brain tissue’s oxygen supply and oxygen demand can cause tissue damage and possible necrosis.
Measurement Location of Oxygen Partial Pressure
The RAUMEDIC NEUROVENT-PTO determines the oxygen partial pressure of the available oxygen in the brain tissue. At the same time, the parenchyma pressure and the temperature are measured in one measuring catheter. Consequently, the NEUROVENT-PTO provides information about three parameters: the ICP (intracranial pressure), the temperature, and the oxygen partial pressure, all in one catheter.
The unique design of NEUROVENT-PTO 2L provides measurement of these three parameters for craniotomies. Furthermore, the NEUROVENT-PTO 2L can be used with the BOLT KIT PTO 2L, which is a 2 lumen bolt. This allows the measurement of ICP, temperature, and oxygen partial pressure in addition to microdialysis through a single access port.
Depending on the indication, it is also possible to use the NEUROVENT-TO to measure the temperature and oxygen partial pressure in the brain tissue.
Recording and Storing of the Oxygen Measurement Values
In addition to the general advantages of the RAUMEDIC measuring catheters NEUROVENT-PTO and NEUROVENT-TO, the oxygen sensor does not change the oxygen content in the brain tissue during measurement of the oxygen partial pressure. The simple and reliable display of the oxygen partial pressure, ICP and temperature measurement values is possible at any time using the EASY logO, but no measurement values are stored in the device.
The MPR2 logO DATALOGGER is available to simultaneously record and store the oxygen partial pressure, ICP and temperature measurement values.
Products for Measurement of Oxygen Partial Pressure
NEUROVENT-TO: Parenchyma temperature and oxygen partial pressure measurement
MPR2 logO DATALOGGER: Documentation and storing of oxygen partial pressure values
EASY logO: Recording the partial pressure of oxygen using the EASY logO
NERUOVENT-PTO 2L: Specially designed parenchyma catheter, applicable for measurement of ICP, temperature and oxygen partial pressure for craniotomy or for implantation with BOLT KIT PTO 2L.
NEUROVENT-PTO: Parenchyma ICP, temperature and oxygen partial pressure measurement
Telemetric ICP Measurement
Indications of Telemetric ICP Measurement
In addition to using catheters to measure intracranial pressure for acute indications, it may, depending on the clinical assessment, also be necessary to measure ICP (intracranial pressure) for an extended duration. One specific indication for longer pressure measurement is hydrocephalus. Hydrocephalus occurs when the production and absorption of CSF (cerebrosoinal fluid) is unbalanced.
In order to monitor the symptoms in hydrocephalus patients with a conventional catheter, the patient must remain in bed. This is a significant disadvantage for the study of hydrocephalus. Monitoring the ICP during movement and as the hydrocephalus patient changes their position provides important insights into how to treat the symptoms.
Information about the ICP is critical for treating hydrocephalus successfully and sustainably. It forms the decision-making basis for the therapy form. For example, whether a patient needs a shunt valve, or how to best adjust the shunt valve for draining the CSF. Both too much and too little drainage should be avoided.
By evaluating the patient’s ICP during normal activity the shunt valve can be optimally adjusted for the patient’s lifestyle, which significantly reduces the number of procedures on the patient’s shunt valve.
Noninvasive ICP Measuring
RAUMEDIC has developed an innovative and unique system based on telemetry, which offers an alternative to traditional ICP monitoring requiring a cable to be connected to a monitor. The telemetric pressure catheter is fully implanted below the scalp on the cranial bone.
The ICP is measured without the use of a cable and is implanted in the parenchyma using the NEUROVENT-P-tel.
The telemetric system measures ICP using microchip technology which transfers pressure values over the closed scalp (without requiring a cable) using validated RFID principles to a reader (Reader TDT readP). The data is captured and stored on the RAUMEDIC MPR 1 DATALOGGER. The light-weight and practical device does not limit the patient’s mobility.
Advantages of the Telemetric ICP Measurement
- Minimal risk of infection
- Cableless communication with the telemetric catheter
- Fully implanted pressure measuring catheter
- Data recorded with the RAUMEDIC MPR 1 DATALOGGER
- Mobile patient monitoring in an inpatient setting
- Reduction of inpatient treatment time
- Reduced exposure to MR and CT
- Telemetric catheter can be implanted for up to 3 months
Telemetric ICP Measuring Products
Telemetry System: Transdermal telemetry system for parenchyma measuring of ICP with the MPR 1 DATALOGGER
NEUROVENT-P-tel: Telemetric ICP measuring in the parenchyma
Reader TDT1 readP: RFID reader for wireless communication with the catheter
DATALOGGER and EASY logO for Neuromonitoring
Large Memory – Minimal Weight
RAUMEDIC developed the MPR 1 DATALOGGER and the MPR2 logO DATALOGGER to record, analyse and display neuromonitoring data. The DATALOGGER are simple to operate and very light weight. DATALOGGER also have a large memory capacity, two analogue outputs and a USB interface.
In addition, we offer the EASY logO for the sole purpose of displaying physiological parameters. While the EASY logO will not store the measured values, these values may be forwarded to the patient monitor via two analogue outputs. The EASY logO is simple to operate and light weight.
Uses of DATALOGGER and EASY logO
In addition to its traditional use as a monitoring device, the MPR 1 DATALOGGER is also used in RAUMEDIC’s telemetric pressure applications. The MPR 1 DATALOGGER measures and displays ICP (intracranial pressure) as well as temperature during the wired measurement and ICP during the wireless, telemetric measurement. The MPR 1 DATALOGGER stores the measured values directly in the device and enables extensive data examination.
The MPR2 logO DATALOGGER records not only ICP and temperature, but also oxygen partial pressure and stores the values in the device. By that the MPR2 logO DATALOGGER allows the comprehensive analysis of stored parameters.
EASY logO is used just to display the ICP, the temperature and the oxygen partial pressure. Storing the measured values in the device is not possible.
RAUMEDIC offers the full range of accessories for DATALOGGER and EASY logO. This enables the transfer of pressure measurement values (ICP and oxygen partial pressure) to the patient monitor. With the related software DATALOG it is possible to archive and visualise the saved parameters from the DATALOGGER directly on the PC.
MPR2 logO DATALOGGER: to record and store oxygen partial pressure, ICP and temperature data
MPR 1 DATALOGGER: to record and store ICP and temperature data
EASY logO: to display oxygen partial pressure, ICP and temperature