Bedside external ventricular drain placement for the treatment of acute hydrocephalus

Abstract

The purpose of this retrospective study was to evaluate the results of external ventricular drain (EVD) placement for the management of hydrocephalus. We present our experience with 103 consecutive cases over one year, 56 of which had subarachnoid hemorrhage (SAH). Short tunnel ventriculostomy was performed at the bedside in the neurosurgical intensive care unit (NSICU), using sterile technique. Long-term care included meticulous site care by a dedicated NSICU nurse, daily cultures and prophylactic antibiotics. The average duration of EVD was 10.7 days (range 1-28 days). There was one case of positive cerebrospinal fluid (CSF) culture. Additional complications included one small intraparenchymal hematoma and two cases of EVD disconnection. No patient died form EVD-associated complications. No rebleed from aneurysmal SAH was seen. There was no correlation between the duration of EVD and infection. We conclude that placement of short EVD in the NSICU is safe and can be maintained for the required duration of treatment with minimum infection rate.

Malplacement of Ventricular Catheters by Neurosurgeons: A Single Institution Experience

“…Our reported hemorrhage rate of 7.1% following ventricular catheter insertion is markedly lower than contemporary reports [4][5][6][7]. Most of the hemorrhages identified in our analysis were small and produced little mass effect.…”

“…Most of the hemorrhages identified in our analysis were small and produced little mass effect. Only 1.9% of our patients were noted to experience a neurologic change as a consequence of their hemorrhage-a frequency along the lower spectrum of other reports within the literature [5,6,8]. The one mortality and one operative intervention in our series were both from large mass producing hemorrhages.…”

Bleeding and Infection With External Ventricular Drainage

“…There were some studies that did not specify the culture frequency. There was no obvious difference in the infection rate between retrospective vs. prospective, both the highest 19 and the lowest 20 reporting infection rate studies were retrospective analyses. The location of EVD placement varied from intensive care unit to operating room in CLEAR III and in the various reported studies, and this did not appear to influence infection rates.…”

Hemorrhagic Complications of Ventriculostomy Placement: A Meta-Analysis

“…The reported intracerebral hemorrhage rate due to ventriculostomy placement varies widely, ranging from 0 to 32.5% [1][2][3][4][5][6][7][8][9][10][11][12][13]. Recent peer-reviewed publications describe both the placement of ventriculostomies by non-neurosurgeons, and the implementation of alternative ventriculostomy techniques [5,7,8,13].…”