Fiber optic technology can be used in both types of devices. A VC inserted into the lat- eral ventricle allows for drainage of cerebrospinal fluid (CSF), which can help reduce ICP. A parenchymal ICP device is inserted into the brain parenchyma and allows for monitoring of ICP, but not CSF drainage. The absence of published stud- ies showing that management of elevated ICP has an effect on ICH outcome makes the decision whether to monitor and treat elevated ICP unclear in patients with ICH. Risks associated with ICP monitors include infection and intracranial hemor- rhage. The risk of hemorrhage or infection is thought to be higher with VC than with parenchymal catheters, although data on these rates are not derived from patients with ICH but principally from those with traumatic brain injury or aneurys- mal subarachnoid hemorrhage. In a 1997 series of 108 intrapa- renchymal devices, the rate of infection was 2.9% and the rate of intracranial hemorrhage was 2.1% (15.3% in patients with Two of 22 patients (9%) patients in the pla- cebo arm of a trial of intraventricular thrombolysis developed ventriculitis, but these patients had multiple intrathecal injec- tions, which could potentially increase the risk of infection.184 Before insertion of a monitoring device, the patient s coagula- tion status should be evaluated. Prior use of antiplatelet agents may justify platelet transfusion before the procedure, and the use of warfarin may require reversal of coagulopathy before placement. The decision to use a VC or a parenchymal cath- eter device should be based on whether there is a need to drain CSF to treat hydrocephalus or elevated ICP. 