Elevated ICP after ventriculostomy requires immediate reporting to protect brain perfusion.

Let me set the scene: you’ve just placed a patient with a ventriculostomy, and a bundle of numbers sits on the monitor like a tray of orders at a busy hospital. One reading stands out, and it isn’t the same as the others. The question that follows isn’t just a test of memory; it’s about recognizing a red flag that can mean the difference between a stable brain and a crisis.

What the numbers are telling you, in plain language

First, a quick refresher so we’re all on the same page. A ventriculostomy creates a direct channel to measure and sometimes drain cerebrospinal fluid (CSF). It’s a lifesaving tool, but it also means you’re now watching for shifts in intracranial dynamics. The key values you’ll monitor include:

• ICP, intracranial pressure: the pressure inside the skull.

• CPP, cerebral perfusion pressure: roughly the pressure that drives blood to the brain.

• PaCO2, the carbon dioxide level in the blood, which helps regulate blood flow to the brain.

• Temperature: fever can hint at infection or inflammatory processes.

In a resting adult, normal ICP tends to hover between about 7 and 15 mmHg. When it climbs above that range, trouble can loom.

Why ICP 24 mmHg is the moment to speak up immediately

You’ll see the right answer to the question whispered in the margins of every neurocritical care guideline: an ICP of 24 mmHg is a red flag. Here’s why that number matters.

• Brain pressure is higher than it should be. Elevated ICP means the brain is under pressure, and that pressure can compress brain tissue and cut off blood flow.

• Getting enough blood to the brain is crucial. If ICP stays high, cerebral perfusion can drop, even if your CPP looks “okay” on the surface. Small changes in pressure can tilt the balance from life-sustaining to life-threatening.

• The risk of herniation grows with rising ICP. When the brain is squeezed from its normal space, parts of it can be pushed toward structures they don’t belong near. That’s a direct path to severe injury.

In other words, 24 mmHg isn’t just a number on a screen—it’s a signal to act fast. It calls for evaluation, confirmation of the drainage setup, and likely orders to reduce pressure and protect brain tissue.

Why the other readings aren’t the urgent red flag here

Let’s give the other values their due and explain why they aren’t the reason to scramble in this moment.

• Temperature 98.4 °F: This is a normal temperature. Fever can be worrisome in neuro patients, but a normal reading at this moment doesn’t indicate an immediate neurosurgical problem.

• CPP 70 mmHg: That’s typically considered acceptable for brain perfusion in many adults. It signals that blood flow to the brain is likely adequate, at least from a perfusion standpoint, given the current ICP.

• PaCO2 35 mmHg: This is within the expected range for an adult at rest. Carbon dioxide levels influence cerebral blood flow, but 35 mmHg doesn’t point to an acute respiratory threat.

So, the unambiguous “call-to-action” is the ICP 24 mmHg. It’s the number that tells you something in brain physiology is off and needs immediate attention.

What you do in the moment (the nurse’s practical to-do list)

When you spot a high ICP reading, you’re in a critical moment where clear, decisive steps matter. Here’s a practical flow you’ll recognize in clinical reality:

1. Notify the team without delay

• Call the physician or the neuro intensivist, and alert the rapid response if you’re in a setting that uses that protocol. Time matters.

2. Reassess the patient for signs of deterioration

• Look for changes in pupils, level of consciousness, motor responses, or new headache. Even subtle shifts can signal the brain is struggling.

3. Inspect the ventriculostomy setup

• Check that the external drainage system is patent and not kinked or blocked.

• Confirm the drain is leveled correctly with the foramen of Monro or per your institution’s standard, and ensure the zero reference is appropriate.

• Verify the tubing isn’t clamped or obstructed and that there’s no CSF overdrainage if the patient’s governed by specific orders.

4. Optimize positioning and airflow

• Elevate the head of the bed to 30 degrees if not contraindicated, and keep the head midline to aid venous drainage.

• Avoid neck flexion, bending, or positions that impede venous outflow.

5. Minimize factors that can worsen ICP

• Limit unnecessary coughing, straining, or agitation. Calm, scheduled analgesia or sedation as guided.

• Maintain normothermia and careful fluid management per orders.

6. Be prepared for escalation

• Depending on orders, hyperosmolar therapy (like mannitol or hypertonic saline) or neurosurgical interventions may be required to bring ICP down.

• Continuous monitoring may be intensified, and repeated neuro checks become more frequent.

Where did the line between knowledge and action blur for you? That moment you realize the clock is ticking, and a single reading can set a cascade of responses into motion. It’s precisely the kind of scenario that tests not just what you know, but how you apply it with calm, clinical judgment.

A quick, reader-friendly memory aid

If you’re ever in doubt, lean on this simple mental pattern: “ICP high means act quick.” While CPP, PaCO2, and temperature are important, it’s the intracranial pressure that demands immediate attention. If you’re ever unsure which reading to escalate, favor the one that directly speaks to the brain’s internal pressure.

Bringing the big picture into focus

Candor often helps in nursing—being honest about what you know, what you don’t, and what you’re doing about it. When you’re studying for licensing exams in neurology and sensory systems, you’re not just memorizing numbers; you’re building a way to read a patient’s story in a few seconds. The ventriculostomy scenario is a perfect example: ICP tells you the current state of intracranial dynamics, while CPP, PaCO2, and temperature help you understand perfusion, respiratory status, and infection risk in context.

In the clinical world, you’ll hear directives that sometimes feel like a chorus. There will be orders to optimize drainage, to adjust the patient’s position, to tune analgesia, and to monitor for complications. The skill is in listening for what the patient’s brain is saying through those numbers and translating it into timely, precise actions.

A few practical study notes you can carry into the next shift

• Always verify the ICP reading in the context of the patient’s overall status and the trend over time. A single spike is red; a rising slope over hours is a louder alarm.

• Keep communication crisp and documented. When you notify the team, include the exact value, the trend, and any associated signs (new weakness, pupil changes, decreased responsiveness).

• Remember that high ICP is a medical emergency. The goal is to prevent secondary brain injury by maintaining adequate perfusion and minimizing secondary insults.

• Don’t assume normal CPP means all is well. If ICP is high, you could still be compromising brain perfusion despite a “normal” CPP reading. The brain doesn’t read the numbers the same way we do; it experiences the effects.

A closing thought

If you stay curious and calm in the face of a high ICP, you’re already on the right path. The ventriculostomy is a powerful tool, but it comes with the responsibility to interpret what the brain is telling you in real time. The moment you recognize that ICP of 24 mmHg needs urgent attention is the moment you pivot from understanding to action. And that, in clinical nursing, is where the most meaningful care happens.

If you’re shopping for more real-world clarity, you’ll find many resources that describe ICP management, EVD care, and neurocritical care principles in practical terms. Look for case studies, standard protocols, and nursing journals that connect clinical guidelines with bedside practice. The more you see these threads woven together—the physiology, the numbers, the steps you take—the more confident you’ll become at guiding patients through their most vulnerable hours.

So next time you see ICP creeping up toward the upper end of the normal range, remember: it’s not just a number. It’s a signal to intervene, to collaborate, and to advocate for that delicate balance your patient relies on for a safer recovery. And that balance—the art and science of neuro care—is what makes nursing both challenging and incredibly rewarding.