To set up an intracranial pressure (ICP) monitoring system, use strict sterile technique. Use the two-person method when priming the tubing with normal saline solution so that the second person can monitor the sterile technique and assist as needed.¹ Follow these steps:

• Put on a cap and mask.^3,4,5
• Perform hand hygiene.^{6,7,8,9,10,11}
• Open a sterile towel on a bedside table to create a sterile field.
• On the sterile field, place a 30-mL or 40-mL syringe filled with preservative-free sterile normal saline solution and a disposable flushless transducer.¹
• Put on a sterile gown and sterile gloves.^3,4,5
• Attach the flushless transducer to the panel mount stopcock.¹
• Using sterile technique, attach the syringe containing sterile preservative-free normal saline solution to the stopcock at the distal end of the tubing (patient line stopcock).¹
• Turn the stopcock off toward the drainage device.¹
• Slowly inject the preservative-free sterile normal saline solution toward the distal end (patient end) of the tubing (as shown below). As the fluid reaches the distal end of the tubing, allow several drops of the solution to exit the end of the tubing to make sure air is cleared from the tubing.¹

• Turn the stopcock off to the distal end of the tubing, keeping the syringe in place. Make sure that the panel mount stopcock is open to the flushless transducer. Prime through the vented caps in the flushless transducer. Replace the vented caps with dead-end caps.¹
• With the syringe remaining in place, turn the stopcock off to the flushless transducer, and prime preservative-free sterile normal saline solution into the drip chamber.¹
• After priming the system, keep the stopcock on the distal end (patient end) of the tubing off to make sure that no normal saline solution leaks from the system before connection.¹
• Connect the flushless transducer to the bedside monitor with a pressure cable that’s plugged into the designated pressure module.¹
• Align the zero point with the center line of the patient’s head, level with the middle of the ear, using a leveling device. Keep in mind that the key to accurate ICP measurement is to use the same landmark each time you check the zero reference level.¹
• Lower the flow chamber to zero, and turn the stopcock off to the dead-end cap.
• Remove and discard your gloves and other personal protective equipment.^4,5
• Perform hand hygiene.^{6,7,8,9,10,11}
• With a clean hand, balance the ICP monitoring system according to the manufacturer’s guidelines.
• Perform hand hygiene.^{6,7,8,9,10,11}