Ansar Hayat, Desi Rodrigues, Peter Crawford, David Mendelow.
External ventricular drains - can morbidity be reduced.
Pak J Neurological Sci Jan ;4(1):1-3.

Objectives: External ventricular drain (EVD) catheters are of major importance in the treatment of patients with head trauma, subarachnoid haemorrhage (SAH), and other causes of increased intracranial pressure (ICP). Although these catheters are used frequently they are not without complications which can at times be life-threatening. Although CSF infection is a considered a major cause of EVD-related morbidity, we have identified other factors contributing to the morbidity of these patients and we propose ways to minimize these problems. Methods: Patients who underwent EVD insertion between 1st May 2006 and 30th Oct 2006 were included. Treatment records of 50 patients were reviewed - 35 retrospectively and 15 prospectively. Indications for placement of EVDs were recorded. The main use of the drain was to monitor ICP and prevent secondary hydrocephalus in SAH, IVH, posterior fossa bleed, head trauma, shunt blockage, and administration of intrathecal antibiotics. Results: Ages of patients ranged from 1.5 years to 85 years; 27 (54%) were females and 23 (46%) were males. Prophylactic antibiotics were used in 70 % of cases. Average duration of drain was 5.9 days. Image guidance equipment was used in one case only. The ventricles were reached with first pass in 48 %, 2% with 2nd pass and 2% with 4th pass, while this information was not available for the remaining cases. In the 42 (84%) cases where post operative images were available, 9(21%) had the EVD in a suboptimal position. Where CSF analysis was available, WBC count was >100 in 21 (50%) and the organism was isolated in 13 (30%). Overall 20 different incidents of minor or major complications were identified and the common ones included EVD blockage in 7, leak of CSF from EVD site in 4, infection in 6, and EVD-related hemorrhage in 3 cases. Conclusion: A written protocol for EVD insertion, nursing and surveillance should be implemented. Regular CSF specimens should be sent for analysis while the EVD is in place. If image guidance is not used during the procedure, at least one post-operative scan should be obtained within 24 hours of insertion of the drain. Malposition of EVD is not uncommon (21%) and image guidance should improve this.

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