Extended subcutaneous tunnelling technique for external ventricular drainage

Abstract

Infection is a serious complication of external ventricular drain (EVD) and various strategies have been adopted to minimize its occurrence. The use of an extended subcutaneous tunnel (50-60 cm) was previously described, but has since received little attention in the literature. The authors reviewed their experience with this technique, with emphasis on the rate of infection and predisposing risk factors. This is a retrospective review of 114 patients who received EVD with extended subcutaneous tunnel ('long EVD'). Fourteen of the 114 patients underwent more than one insertion, and a total of 133 cases of 'long EVD' were included. The mean duration of drainage was 20 days. One-hundred-and-three cases started without pre-existent infection and seven became infected, yielding an overall infection rate of 6.8%. The majority of infections were found within the first 5 days and in the third week of drainage. There was, however, no statistically significant difference in daily infection risks between the first, second and third weeks. Only intraventricular instillation of urokinase was identified as a statistically significant risk factor. Non-infective complications occurred in 17 cases (12.8%). In the present study, the overall infection rate of the 'long EVD' was comparable with that of conventional EVD, as reported by other authorities in the literature. The extended subcutaneous tunnel technique did not affect the daily infection risk on a week-to-week basis. The 'long EVD' does not appear to offer any distinct advantage over the standard tunnelling technique in our unit. However, this is essentially an audit within a single centre, and the findings should be interpreted with caution and with the understanding that individual institutions may have their unique patterns and risks of EVD infection.

Do Iatrogenic Factors Bias the Placement of External Ventricular Catheters? -A Single Institute Experience and Review of the Literature-

“…1,3,5,8,10,14,19,21) In coherence with the admitting diagnosis followed by operative intervention and an extended ICU abidance, these factors can be assumed to increase the risk of ventriculostomy-related infection. Our results showed that the ventriculostomy-related infection rate was significantly higher in secondary EVD placements compared to primary procedures.…”

“…However, previous studies showed that these antibiotic impregnated EVDs are superior compared to standard EVDs in this high risk patient subgroup. 8,10,14,19,21) Therefore, based on this knowledge, we decided to use only Bactiseal EVDs in these patients to guarantee the best patient outcome.…”

“…The optimal intraventricular endpoint was defined as in front of the ipsilateral foramen of Monroe, 1,7,15) and the maximum insertion depth of the catheter was 6-7 cm. The catheter was subcutaneously tunneled as far as possible from the skin incision, 14) and was connected to a standardized gravity-dependent drainage system. The procedure for the occipital approach used Frazier's point (7 cm above the inion and 3 cm lateral of the midline with an catheter insertion depth of 9 cm).…”

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].…”

External Ventricular Drain Infections

“…Aucoin et al reported a 6% increase in relative risk of infection for patients whose EVD was flushed www.intechopen.com with bacitracin solution (Aucoin, et al, 1986). A previously published report by the present authors also demonstrated intraventricular urokinase infusion as one of the risk factors for infection (Leung, et al, 2007). Historically, CSF was sampled routinely and indeed daily in some centers in an attempt to pick up early infections.…”