Management of the patient with an external ventricular drain. An external ventricular drain evd is a temporary drain that drains cerebrospinal fluid csf from the lateral ventricles in the centre of the brain to an external reservoir. External ventricular drainage systems are often necessary in neurological and neurosurgical patients. Treatment and prognosis complications infection evd malfunction evd malposition intracrani. The evd consists of a thin plastic tube catheter which is placed into the ventricles of the brain and connected to an external drainage system. This technique is lifesaving for patients suffering from lifethreatening hydrocephalus and intraventricular hemorrhage. System components facilitate ventricular drainage, fluid injection, csf sampling and intracranial pressure icp monitoring when used in conjunction. Surveillance of external ventricular drainageassociated.
Care of the patient undergoing intracranial pressure. External ventricular drain radiology reference article. External ventricular drains evds and lumbar drains lds are temporary devices placed into the lateral ventricles of the brain and lumbar subarachnoid space, respectively, to facilitate external cerebrospinal. An external ventricular drain is a medical device that can direct cerebrospinal fluid csf from inside the brain to a bag outside the body. Catheters impregnated with antibiotics rifampicin and minocyclin or rifampicin and clyndamycin reduce the frequency of. Abstract external ventricular drains are lifesaving devices used in. Evds and icp monitors have historically been placed by neurosurgeons. The external ventricular drain evd catheter is an alternative method for monitoring and controlling elevated icp. External ventricular drainage evd or lumbar drainage or externalized ventriculoperitoneal shunt1,2 cerebral spinal fluid is colorless, clear fluid produced in the 3rd thand 4 ventricles of the brain that functions to cushion the brain and spinal cord. External ventricular drains evds and intracranial pressure icp monitors are widely used in the neurological critical care unit nccu to measure icp and divert cerebrospinal fluid csf. A total of 77 evd placements in 70 patients were evaluated. Ventricular drain evd is a common life saving measure in a neurosurgery. Correct placement of the ventricular drainage collection system, a nursing responsibility, is key to the process, and has the potential to influence patient outcome.
External ventricular drain an overview sciencedirect. A temporary system that allows drainage of cerebral spinal fluid csf from the ventricles to an external closed. The catheter is attached to a drainage bag outside the body where the fluid is collected. Perioperative management of external ventricular evd and lumbar drain ld. Some experts recommend a rapid weaning of the evd after the aneurysm is secured, or within 48 hours of evd placement, for patients who are neurologically. External ventricular drains and intracranial pressure. Shunt patency can be grossly evaluated by manual pumping of the shunt valve. A freehand pass technique using surface landmarks is commonly used by surgeons to place an evd. In light of the infection risk associated with external ventricular drainage evd, we decided to establish the surveillance of evdassociated meningitisventriculitis in german intensive care units icus in the framework of the german national. Transducer must be level with foramen of monro inner ear. Evd catheters are connected to an external drainage and monitoring system. A ventriculostomy ventric is a device that drains excess cerebrospinal fluid csf from the head. Drainage irrigation potential reduction of catheter occlusion due to automated cleansing of the catheter tip a catheter designed for controlled irrigation, enhancing the ability to remove. Extraventricular drainage system and icp monitoring.
While both parenchymal icp monitors and evds provide reliable and accurate icp data, evd are preferred in patients with hydrocephalus. Evdrelated infection eri is a major complication that can lead to morbidity and mortality. This can be prevented in some instances by intermittently clamping the evd if the patient has a transient increase in icp e. Occult cerebrospinal fluid fistula between ventricle and. In this study, we aimed to establish a national eri rate in the uk and ireland and determine key factors influencing the infection risk. Setup of the exacta external drainage and monitoring system. A thin plastic tube, called a catheter, is placed into ventricles in the brain that contain the fluid. The system is made up of a small tube, drainage bag, and monitor.
Evd catheters can be fabricated of radiopaque barium impregnated silicone tubing, translucent silicone tubing, or a. Infections are a serious complication of external ventricular drainage. Understand the principles of external ventricular drainage evds. Major indications for placement of external ventricular and lumbar drains. An email invitation and questionnaire link was distributed in march 2010 to physiotherapists currently working with this.
Placement of external ventricular drains and intracranial. Extraventricular drainage system and icp monitoring turn stopcock to drain csf in burette to bag q1 hour record amount from chamber on io flowsheet notify neurosurgery if. Perioperative management of external ventricular and. It is also used to measure the pressure in the head called intracranial pressure icp. Freehand insertion of external ventricular drainage. Methods a prospective multicentre cohort study of evd insertions in 21. They also provide a way to treat elevated intracranial pressure.
Insertion of an external ventricular drain evd is arguably one of the most common and most important lifesaving procedures encountered in the neurologic intensive care unit. Gravity and the pressure inside the head typically help to drain the csf, which can build up as a result of injury, infection, surgery, or other conditions. Various types of acquired brain injury, such as intracranial hemorrhage with intraventricular extension, subarachnoid hemorrhage, traumatic brain injury, and bacterial meningitis, may benefit from evd insertion. Evd external ventricular drain is a catheter used to measure icp that also allows external. The ventricular system is continuous with the central canal of the spinal cord from the fourth ventricle, allowing for the flow of csf to circulate all of the ventricular system and the central. The ventricular system is a set of four interconnected cavities ventricles or lumen in the brain, within each ventricle is a region of choroid plexus where the cerebrospinal fluid csf is produced. Intervention to reduce intracranial pressure using external. Ventriclear evd catheter external ventricular drainage. Perioperative management of extraventricular drains evd. If drainage exceeds reportable limits the neurosurgeon must be contacted as the risk of excessive drainage can lead to collapsed ventricles or a subdural haemorrhage. External ventricular drains evds are a common neurosurgical procedure used to monitor and treat raised intracranial pressure in the acute setting. Results of the epract study author links open overlay panel bhunyawee alunpipatthanachai 1 porntip thirapattaraphan 2 herbert fried 3 monica s.
The aim of this study was to evaluate the influence of total drainage time on the risk of catheter infection, and the predictive value of standard laboratory examinations for the diagnosis of bacteriologically recorded cerebrospinal fluid csf infection during external ventricular drainage. An extra point is received for ivh that expands the given space. Connect ventricular or lumbar catheter under sterile conditions attach pressure cable to flushless transducer. To describe current mobilization practices of canadian physiotherapists when treating patients with external ventricular drains evds.
However, more intense drainage done by decreasing the level may be necessary depending on the patients disease process. Infections cannot be avoided even with the best surgical technique and aseptic handling measures. External drainage and monitoring is the temporary drainage of cerebrospinal fluid csf from the lateral ventricles of the brain, or the lumbar space of the spine, into an external collection bag. Prospective, multicentre study of external ventricular. Overview of external ventricular drainage and monitoring. The external ventricular drain evd and intracranial pressure icp. Peter suffered from ventricular tachycardia vt, an abnormally fast heart rhythm which is potentially lifethreatening as may lead to. Drainage color change turn stopcock off to burette after draining zero q shift, when reconnecting to. External ventricular drainage evd catheters act as a pathway to drain csf from the patients ventricles to help relieve intracranial pressure. Intracranial pressure monitoringexternal ventricular drainage or lumbar.
Results of routine ventriculostomy with external ventricular drainage for acute hydrocephalus following sah. Introduction the insertion of ventricular catheter is one of the most commonly performed procedures in neurosurgery. External ventricular drainage for intraventricular hemorrhage. Caring for neurosurgical patients with external ventricular drains.
Although cns infection rates as high as 27% have been reported in patients undergoing evd placement, highest rates of infection occurred in patients who had an evd in place for an average of 8. The fluid is produced in the brain ventricles and circulates around the brain and spinal cord, protecting them from injury and supplying brain cells with nutrients. Does duration and sampling of external ventricular. Label the components of an evd and describe the purpose of each component c. External ventricular drains are lifesaving devices used in neurosurgical patients with hydrocephalus excessive amounts of cerebrospinal fluid. Insertion of an external ventricular drain evd is arguably one of the most common and important lifesaving procedures in neurologic. Thus, an mgs of 3 in the temporal and occipital poles and an mgs of 5 in the lateral and third and fourth ventricles indicates a full ventricle with dilation. Early diagnosis of external ventricular drainage infection. The worlds first irrigating ventricular drainage system. External ventricular drains and intracranial pressure monitoring. The ventricular drainage system, model nl850500v see figure 1, provides a sterile fluid path for the drainage of cerebrospinal fluid csf from an intraventricular catheter to a collection bag. This guideline replaces two previous guidelines, care of the patient with intracranial pressure monitoring and care of the patient with a lumbar drain. Objectives external ventricular drain evd insertion is a common neurosurgical procedure.
Describe the nursing care of a patient with an evd d. Liverpool health service icu patient care manual, department of nursing, 2009. Practice patterns of canadian physiotherapists mobilizing. Third and fourth ventricular dilation was determined by comparison with older or preceding scans. External ventricular drain an overview sciencedirect topics.
An external ventricular drainage evd system drains csf by using a combination of. Over drainage of csf subdural or epidural hematoma. During a three year period, all patients of the neurosurgical intensive care unit. Because the fistula exists, csf drainage via vp shunt continued. Perioperative management of adult patients with external. Instructions for use prior to system use, it is necessary for. An external ventricular drain, also known as an extraventricular drain or ventriculostomy, is a device used in neurosurgery that relieves elevated intracranial pressure and hydrocephalus when the. Failure of the drainage system may be evidenced by continuing symptoms of increased icp.
Purpose to appropriately manage the patient with an external ventricular drain evd 1. Any failure of the system requires immediate replacement of the drainage system or the affected component. Risk factors and outcome article pdf available in interdisciplinary perspectives on infectious diseases 2014. Haemorrhagic complications of external ventricular drainage. Risks of an insertion of external ventricular drain there are risks and complications with this procedure. External ventricular drain the neurosurgical atlas, by. Scroll down to read the article or download a printfriendly pdf here. External ventricular drain management practices in thailand. Insertion of an external ventricular drain evd is arguably one of the most common and important lifesaving procedures in. Monitoring learning package is designed to increase the nurses awareness of the.
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