A Narrative Review of the Published Literature, Hospital Practices, and Policies Related to External Ventricular Drains in the United States: The External Ventricular Drain Publications, Practices, and Policies (EVDPoP) Study

Abstract

External ventricular drain (EVD) placement and management pose risks to neurocritically ill patients. Yet, little is known about EVD management or hospital EVD management practices and policies in US hospitals. A narrative review was conducted to describe EVD-related publications reported in PubMed and Embase between 1953 and 2019, and a survey was used to examine US hospital EVD practices and policies, including adherence to EVD guideline recommendations. Overall, 912 relevant articles were published between 1953 and 2019 (average 21; range, 0 to 102 articles, per year), primarily related to indications for EVD placement (n = 275, 30.2%), EVDassociated complications (n = 206, 22.6%), and EVD care (n = 200, 21.9%). The number of EVD publications increased over time (R 2 = 0.7), and most publications addressed EVD-associated infection (n = 296, 73.4%) and EVD insertion (n = 195, 45.2%). Survey responses were received from 30 hospitals (37.5% response rate), and reported use of antimicrobial-impregnated catheters in 80% of hospitals, preinsertion antibiotic administration in 70%, collection of cerebrospinal fluid samples for suspicion of ventriculitis in 73.3%, tracking of EVD-associated infection in 86.7%, routine EVD clamping during transport in 66.7%, and monitoring of intracranial pressure during transport in 33.3%. Adherence to hospital policies was high for recommendations related to flushing an EVD and changing cerebrospinal fluid drainage systems (100% [range, 0% to 100%] each), but low for intrahospital transportation (16.7% [0% to 83.3%]), EVD removal (0% [0% to 66.7%]), patient and family

2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

“…[390][391][392]394 Although the literature on the elements of a bundled protocol varies, the primary considerations should include a protocol that addresses insertion and technique, management, monitoring, and education. [388][389][390][391][392]394,395 Recommendation-Specific Supportive Text 1. The risk of acute hydrocephalus after aSAH ranges from 15% to 87% in the acute stage.…”

“…393 This same review, along with others, summarized key practices for EVD insertion and maintenance bundles. [390][391][392][393][394]396 Aseptic technique and the use of antibiotic impregnated catheters are widely accepted as best practices to decrease CSF positive cultures and reduce rates of ventriculostomy-associated infection. [390][391][392][393][394][395][396] The place of insertion, inserting physician, type and size of catheter, and the antibiotic coating vary widely.…”

“…[390][391][392][393][394]396 Aseptic technique and the use of antibiotic impregnated catheters are widely accepted as best practices to decrease CSF positive cultures and reduce rates of ventriculostomy-associated infection. [390][391][392][393][394][395][396] The place of insertion, inserting physician, type and size of catheter, and the antibiotic coating vary widely. Although the evidence suggests that reduced sampling and use of aseptic technique decrease rate of ventriculostomy-associated infection, there is not enough literature to support specific recommendations for this intervention.…”

“…[389][390][391]393,395 Use of a targeted, bundled EVD management protocol has been identified as a best practice for prevention of ventriculostomy-associated infection and other associated complications. [390][391][392]394 Although the literature on the elements of a bundled protocol varies, the primary considerations should include a protocol that addresses insertion and technique, management, monitoring, and education. [388][389][390][391][392]394,395 Recommendation-Specific Supportive Text 1.…”

Implementation of an Online External Ventricular Drain Training Module—An Educational Initiative to Improve Proficiency of Perioperative Health Care Providers: Results of a Retrospective Study

“…We found significant variation between centers in the following 4 areas: (1) ability to identify a normal ICP waveform, (2) factors associated with elevated ICP when transporting patients with the EVD clamped, (3) the possibility of draining CSF and accurately measuring ICP at the same time, and (4) the elements to be considered during transport to/from the intensive care unit. Based on the EVD aware3 and the EVD PoP8 studies, there is heterogeneity among hospital EVD policies. The heterogeneities related to intrahospital transport may be evident in the responses to these questions in the module.…”