Factors associated with external ventricular drain placement accuracy: data from an electronic health record repository

Patil, Vithoba L.; Lacson, Ronilda; Vosburgh, Kirby G.; Wong, Judith M.; Prevedello, Luciano M.; Andriole, Katherine P.; Mukundan, Srinivasan; Popp, Andreas; Khorasani, Ramin

doi:10.1007/s00701-013-1769-y

Cited by 37 publications

(27 citation statements)

References 27 publications

(84 reference statements)

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“…This effect is unlikely to be secondary to physician practices, as the incidence of acceptable catheter position is consistent with previous retrospective studies reporting 77% to 87% "acceptable" catheter position rates (although the definitions are somewhat different). [7][8][9]16 Recent studies have indicated a 20% to 45% risk of hemorrhage with placement: 6,8,10,19 the 28% hemorrhage incidence after virgin catheter placement in this study falls within this range. In this study, hemorrhage was determined based on the first postprocedural CT imaging.…”

Section: Discussionsupporting

confidence: 50%

The burden and risk factors of ventriculostomy occlusion in a high-volume cerebrovascular practice: results of an ongoing prospective database

Fargen¹,

Hoh²,

Neal³

et al. 2016

JNS

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V entriculostomy occlusion is a common complication after external ventricular drain (EVD) placement. A review of published prospective and retrospective studies indicates that approximately 1% to 7% of EVDs require replacement secondary to occlusion. [1][2][3]5,8,9,20 Furthermore, in a Nationwide Inpatient Sample database study of more than 101,000 hospitalizations in which ventriculostomy was performed, nearly 6% of patients required at least 1 additional ventriculostomy procedure. 18Studies have demonstrated nonpatent EVD in 19% to 47% of patients; 3,4,15 however, no study to date has prospectively evaluated EVD occlusion as a primary end point, reported on the number of catheter irrigations performed, or identified the risk factors for EVD occlusion.The morbidity and costs associated with the occlusion of EVD catheters is not insignificant. Patients with nonfunctional catheters often require CT imaging to evaluate the catheter position, subjecting the patient to ionizing radiation. Replacement of EVD catheters may be costly and uncomfortable for patients. In addition, studies have documented an increased risk of ventriculostomy infection with replacement. 4,12 Finally, catheter irrigation performed to restore the patency of occluded catheters may not be a benign maneuver (unpublished results). OBJectiVe Ventriculostomy occlusion is a known complication after external ventricular drain (EVD) placement. There have been no prospective published series that primarily evaluate the incidence of and risk factors for EVD occlusion. These phenomena are investigated using a prospective database. methOdS An ongoing prospective study of all patients undergoing frontal EVD placement in the Neurosurgery Intensive Care Unit at the University of Florida was accessed for the purposes of this analysis. Demographic, procedural, and radiographic data were recorded prospectively and retrospectively. The need for catheter irrigation or replacement was meticulously documented. Univariate and multivariate regression analyses were performed. reSultS Ninety-eight of 101 total enrolled patients had accessible data, amounting to 131 total catheters and 1076 total catheter days. Nineteen percent of patients required at least 1 replacement. Forty-one percent of catheters developed at least 1 temporary occlusion, with an average of 2.4 irrigations per patient. Intracranial hemorrhage occurred in 28% of patients after the first EVD placement (2% resulting in new neurological deficit) and in 62% of patients after 1 replacement. The cost of occlusion is estimated at $615 per enrolled patient. Therapeutic anticoagulation and use of small EVD catheters were statistically significant predictors of permanent occlusion (p = 0.01 and 0.04, respectively). cONcluSiONS EVD occlusion is frequent and imparts a significant burden in terms of patient morbidity, physician upkeep, and cost. This study suggests that developing strategies or devices to prevent EVD occlusion, such as the preferential use of larger diameter catheters, may be beneficial in red...

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Section: Discussionsupporting

confidence: 50%

The burden and risk factors of ventriculostomy occlusion in a high-volume cerebrovascular practice: results of an ongoing prospective database

Fargen¹,

Hoh²,

Neal³

et al. 2016

JNS

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“…Naff et al [15] included daily CT scans during treatment with fibrinolytic and a scan at day 28–32 after enrollment. One study included all CT scans obtained during hospitalization [8] and two used radiology reports [20, 21]. Most studies defined CTH as any hemorrhage/hyperdense lesion along the catheter tract after placement [9, 14, 16, 18, 19, 21] similar to our definition.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies defined CTH as any hemorrhage/hyperdense lesion along the catheter tract after placement [9, 14, 16, 18, 19, 21] similar to our definition. Planar and volume measures were not performed in most studies, and Patil et al [20] did not include trace blood along the tract. In the pooled study of Dey et al, from EVD placement to first CT, CTH rates ranged from 1.8 [20] to 34% [9].…”

Section: Discussionmentioning

confidence: 99%

“…Planar and volume measures were not performed in most studies, and Patil et al [20] did not include trace blood along the tract. In the pooled study of Dey et al, from EVD placement to first CT, CTH rates ranged from 1.8 [20] to 34% [9]. Based on the heterogeneity of patient subtypes and imaging surveillance reported, our CTH incidence does not appear to be excessive given the high-risk condition of ICH with IVH, use of the most stringent definition of CTH, emergent placement, rigorous CT imaging protocol, and multicenter international nature of the CLEAR III study (vs. all singlecenter comparison studies).…”

Section: Discussionmentioning

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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“…Inaccurate placement of ventricular catheters utilizing the freehand technique has been reported in the 15%-45% range. 11,17,22 Misplaced catheters were managed in our service according to the patient's neurological condition-if the patient was awake and stable, external catheters were simply removed and shunts were repositioned electively. If, on the other hand, the patient was sedated or comatose, the catheter was immediately repositioned at bedside (external catheters) or in the operating room (shunts).…”

mentioning

confidence: 99%

Relevance of early head CT scans following neurosurgical procedures: an analysis of 892 intracranial procedures at Rush University Medical Center

Fontes

Smith²,

Munoz³

et al. 2014

JNS

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Object. Early postoperative head CT scanning is routinely performed following intracranial procedures for detection of complications, but its real value remains uncertain: so-called abnormal results are frequently found, but active, emergency intervention based on these findings may be rare. The authors' objective was to analyze whether early postoperative CT scans led to emergency surgical interventions and if the results of neurological examination predicted this occurrence.Methods. The authors retrospectively analyzed 892 intracranial procedures followed by an early postoperative CT scan performed over a 1-year period at Rush University Medical Center and classified these cases according to postoperative neurological status: baseline, predicted neurological change, unexpected neurological change, and sedated or comatose. The interpretation of CT results was reviewed and unexpected CT findings were classified based on immediate action taken: Type I, additional observation and CT; Type II, active nonsurgical intervention; and Type III, surgical intervention. Results were compared between neurological examination groups with the Fisher exact test.Results. Patients with unexpected neurological changes or in the sedated or comatose group had significantly more unexpected findings on the postoperative CT (p < 0.001; OR 19.2 and 2.3, respectively) and Type II/III interventions (p < 0.001) than patients at baseline. Patients at baseline or with expected neurological changes still had a rate of Type II/III changes in the 2.2%-2.4% range; however, no patient required an immediate return to the operating room.Conclusions. Over a 1-year period in an academic neurosurgery service, no patient who was neurologically intact or who had a predicted neurological change required an immediate return to the operating room based on early postoperative CT findings. Obtaining early CT scans should not be a priority in these patients and may even be cancelled in favor of MRI studies, if the latter have already been planned and can be performed safely and in a timely manner. Early postoperative CT scanning does not assure an uneventful course, nor should it replace accurate and frequent neurological checks, because operative interventions were always decided in conjunction with the neurological examination. (http://thejns.org/doi/abs/10.3171/2014.4.JNS132429) Key WoRds • computed tomography • radiography • craniotomy • reoperation • traumatic brain injuryAbbreviations used in this paper: ICU = intensive care unit; RUMC = Rush University Medical Center; TBI = traumatic brain injury.

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Factors associated with external ventricular drain placement accuracy: data from an electronic health record repository

Cited by 37 publications

References 27 publications

The burden and risk factors of ventriculostomy occlusion in a high-volume cerebrovascular practice: results of an ongoing prospective database

The burden and risk factors of ventriculostomy occlusion in a high-volume cerebrovascular practice: results of an ongoing prospective database

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

Relevance of early head CT scans following neurosurgical procedures: an analysis of 892 intracranial procedures at Rush University Medical Center

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