Response to Letter Regarding Article, “Evidence-Based Nursing Review of Craniectomy Care”
Thank you for your thoughtful review. We appreciate the additional nursing consideration points related to the care of the patient after decompressive craniectomy (DC). Both points highlight the importance of considering nursing care implications when evaluating medical therapy and measuring complications associated with any therapy.
In our extensive review of the literature on complications associated with DC and care priorities after DC, train of 4 monitoring was not described in any publications. We agree that electric stimulation with train of 4 monitoring over the orbit of a patient with frontal craniectomy should be avoided. Our review and nursing care priorities should serve as guiding principles that begin the discussion of how to care for such a patient with complex needs. About assessment of skin turgor over the DC site, we agree that nurses can and should be educated to assess the turgor and girth of the DC site in addition to the dressing and wound. However, much like external ventricular drain management is considered a specialty skill requiring training; this assessment should be considered a specialty skill reserved for nurses with neuroscience expertise and knowledgeable about the assessment and potential findings. Again, there is no published literature to guide training in this area. It is our goal that our publication begins the discussion of care tailored to this population of patients and over time yields refined protocols for care as well as studies that evaluate the role nursing care plays in patient outcomes after DC.
Sarah L. Livesay, DNP, RN, ACNP-BC
Hope Moser, DNP, RN, ANP-BC
Comprehensive Stroke Center
Memorial Hermann-Texas Medical Center
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