External ventricular drain placement in the intensive care unit versus operating room: Evaluation of complications and accuracy

Foreman, Paul M.; Hendrix, Philipp; Griessenauer, Christoph J.; Schmalz, Philip G.R.; Harrigan, Mark R.

doi:10.1016/j.clineuro.2014.09.026

Cited by 58 publications

(45 citation statements)

References 17 publications

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“…Some (25.4% of them), however, were placed in the OR and were associated with lower incidence of CTH, fewer placement attempts, and lower proportion of MKS grade 3 location with the EVD tip in eloquent tissue. Foreman et al [10] also reported lower CTH rates in EVDs placed in the OR compared to ICU (4.4 vs. 15.1%), respectively, in a study of 138 patients. Huyette et al [13] reported that freehand ventricular catheterization typically required two passes per successful placement, and 22.4% of catheter tips were in non-ventricular spaces.…”

Section: Discussionmentioning

confidence: 98%

“…Huyette et al [13] reported that freehand ventricular catheterization typically required two passes per successful placement, and 22.4% of catheter tips were in non-ventricular spaces. Although the number of catheter positioning attempts reported in CLEAR III was low, even a small number of misplacements create a safety issue in terms of additional risk of CTH, infection, or non-functional drains which can be reduced by placement in the OR and ideally with stereotactic guidance [10]. …”

Section: Discussionmentioning

confidence: 99%

“…Kakarla et al [8] reported grade 1, 2, and 3 accuracy of 77, 10, and 13%, respectively. Foreman et al [10] investigated placement accuracy for catheters placed in the OR and in the ICU and reported grade 1, 2, and 3 accuracy of 67.7, 25.8, and 6.5% in ICU-placed catheters and 55.6, 42.2, and 2.2%, respectively, in OR-placed catheters. Our results are similar to both studies (combining grades 0 and 1 as “1” from the original Kakarla score).…”

Section: Discussionmentioning

confidence: 99%

“…Dey et al [6] in a systematic review of bleeding and hemorrhage risks with EVD use attributed the wide variation to lack of standard definitions for ascertaining the presence of CTH. Age > 75 years, international normalized ratio (INR) > 1.4, and use of antithrombotic agents have been identified as risk factors for CTH [10–12]. …”

Section: Introductionmentioning

confidence: 99%

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The Incidence of Catheter Tract Hemorrhage and Catheter Placement Accuracy in the CLEAR III Trial

Müller

Mould²,

Freeman

et al. 2018

Neurocrit Care

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Background Incidence of catheter tract hemorrhage (CTH) after initial ventriculostomy placement ranges from 10 to 34%. We investigated CTH incidence in the Clot Lysis: Evaluation of Accelerated Resolution of Intraventricular Hemorrhage Phase III trial. Methods Prospective observational analysis of 1000 computer tomography (CT) scans from all 500 patients enrolled in the trial. All catheters were evaluated on first CT post-placement and on last CT prior to randomization for placement location and CTH size, location, and severity. Clinical variables were assessed for association with CTH with multivariable logistic regression. Results Of 563 catheters, CTH was detected in 14 and 21% of patients on first and last CT (median 3.7 and 43.4 h after catheter placement, respectively). All, but one were asymptomatic. Majority of CTH (86%) occurred within 24 h after placement, were located within 1 cm of the skull, and had at least one diameter > 5 mm. Most catheters (71%) terminated in the third or lateral ventricle ipsilateral to insertion site. Factors significantly associated with CTH were pre-admission use of antiplatelet drugs, accuracy of catheter placement, non-operating room catheter placement, Asian race, and intraventricular hemorrhage expansion. Conclusions CTH incidence on initial catheter placement and during stabilization was relatively low, despite emergent placement in a high-risk population. Catheter placement accuracy was similar or better than convenience samples from the published literature. Decreasing risk of CTH may be achieved with attention to catheter placement accuracy and placement in the operating room. Antiplatelet agent use was an independent risk factor for CTH.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Incidence of Catheter Tract Hemorrhage and Catheter Placement Accuracy in the CLEAR III Trial

Müller

Mould²,

Freeman

et al. 2018

Neurocrit Care

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“…As would be expected, place- ment in the ICU was most commonly performed for head trauma, whereas OR placements occurred for less emergent cases or when placement occurred in conjunction with other neurosurgical procedures (i.e., aneurysm clipping). 18 Concerns about suboptimal placement of EVDs have led practitioners to develop adjunct methods aimed at improving accuracy. Several centers use a custom-made metal bolt for placement of the catheter to reduce the chance of dislodgment or displacement, especially in patients who are confused and/or combative.…”

Section: Misplacement Of Evdsmentioning

confidence: 99%

Complications of invasive intracranial pressure monitoring devices in neurocritical care

Tavakoli¹,

Peitz²,

Ares

et al. 2017

Neurosurgical Focus

142

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Intracranial pressure monitoring devices have become the standard of care for the management of patients with pathologies associated with intracranial hypertension. Given the importance of invasive intracranial monitoring devices in the modern neurointensive care setting, gaining a thorough understanding of the potential complications related to device placement—and misplacement—is crucial. The increased prevalence of intracranial pressure monitoring as a management tool for neurosurgical patients has led to the publication of a plethora of papers regarding their indications and complications. The authors aim to provide a concise review of key contemporary articles in the literature concerning important complications with the hope of elucidating practices that improve outcomes for neurocritically ill patients.

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Placement accuracy of external ventricular drain when comparing freehand insertion to neuronavigation guidance in severe traumatic brain injury

et al. 2017

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AndTo the memory of my mother, Rahma.ii ACKNOWLEDGMENTSThanks go first to my advisor, Dr. Judith Marcoux, who supported me in this endeavor. I have always appreciated the trust she has shown in me. Thanks also to the program director of the neurosurgery residency at McGill University, Dr. Jeffrey Atkinson, who has given me the opportunity to have the time for the master study. I also thank the head of the neurosurgery department, Dr. Kevin Petrecca, who supported me to have the funding of this project, and to Mr. Kelvin Mok, the biomedical engineer at the neuronavigation unit, who was the key point for correspondence for the equipment supply, and who spared his time to help with the training of using the AxiEM navigation system. This project has been made possible by the funding provided by the Medtronic Surgical Technology Neurosurgery, which has provided the navigation system and the disposable kits plus the cost paid to the Research Institute of the Montreal University Hospital Centre. The authors report no conflict of interest concerning the methods used in this study or the findings specified in this paper, and have no personal financial or institutional interest in any of the materials, or devices described in this thesis. iv ABSTRACTExternal ventricular drain (EVD) placement is one of the most frequently performed neurosurgical procedures. Inaccuracies in the drain positioning and the need for multiple passes using the classic freehand insertion technique are increasingly reported in the literature. The problem is seen most frequently in the severe traumatic brain injury (TBI) population. Many proposed methods were discussed to improve the placement accuracy and none gained enough support to be implemented in EVD placement. The purpose of this study is to evaluate the use of electromagnetic neuronavigation guidance to aid EVD insertion to improve the accuracy and minimize the number of passes in severe TBI patients. The navigation was applied prospectively for all new severe TBI patients who required ventricular catheter placement over a year period, and this was compared to a retrospective cohort of severe TBI patients who had EVD inserted freehand in the preceding year. Fifty-four cases were recruited, 35 (64.8%) had their EVD placed using the freehand technique and 19 (35.2%) using navigation guidance. In the navigation group, the placement accuracy was as follows: 94.7% (18/19) achieved a grade 1 and 5.3% (1/19) a grade 2, while none were in

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External ventricular drain placement in the intensive care unit versus operating room: Evaluation of complications and accuracy

Cited by 58 publications

References 17 publications

The Incidence of Catheter Tract Hemorrhage and Catheter Placement Accuracy in the CLEAR III Trial

The Incidence of Catheter Tract Hemorrhage and Catheter Placement Accuracy in the CLEAR III Trial

Complications of invasive intracranial pressure monitoring devices in neurocritical care

Placement accuracy of external ventricular drain when comparing freehand insertion to neuronavigation guidance in severe traumatic brain injury

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