Hemorrhagic Complications Of External Ventricular Drainage

Maniker, Allen H.; Vaynman, Artem; Karimi, Reza; Sabit, Aria O; Holland, Bart

doi:10.1227/01.neu.0000222817.99752.e6

Cited by 77 publications

(99 citation statements)

References 28 publications

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“…However, no allergic reactions were reported in either of the groups and no evident neurotoxic side effects of silver particles were observed in the group with SI catheters. The overall surgical complication rate of 7 % (Table 1) fits in the lower median as reported in literature (range 1-33 %) [3,15,16]. Following a retrospective evaluation of surgical complication rates at the Department of Neu-rosurgery of the University Hospital Zurich [3], a standardized surgical and handling protocol was estab-lished which enabled to reduce the surgical complication rate from 10 to 7 %.…”

Section: Discussionsupporting

confidence: 62%

Antibiotic-Impregnated Versus Silver-Bearing External Ventricular Drainage Catheters: Preliminary Results in a Randomized Controlled Trial

et al. 2013

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BACKGROUND: Evaluation of antibiotic-impregnated (AI) and ionized silver particle coated external ventricular drainage catheters (EVD) in patients with subarachnoid (SAH) or intracranial hemorrhage (ICH). METHODS: Between February 2011 and June 2012, 40 patients with acute hydrocephalus due to SAH, ICH or intraventricular hemorrhage were enrolled in a prospective, randomized, mono-center pilot study. Primary endpoints were defined as: number of events of cerebrospinal fluid (CSF) infections. Secondary endpoints were defined as: neurosurgical complications following the placement of the EVD, number of revisions of EVD catheters, and cost effectiveness. RESULTS: Sixty-one EVD placements in 40 patients, 32 antibiotic-coated (Bactiseal(®)), 29 silver-bearing catheters (VentriGuard(®)), have been performed. Confirmed or high suspicion of CSF infections occurred in 11 out of 61 events (confirmed infection: p = 0.71, probable infection: p = 0.90). Revisions of EVD were needed in 13 cases (22 %) due to CSF infection, dysfunction, impaired healing, or malplacement (p = 0.37). CONCLUSION: Regarding CSF infection rate and dysfunction, no statistical significant differences between the two EVD catheters Bactiseal(®) versus VentriGuard(®) were found. The silver-bearing catheter might offer a safe and cost-conscious alternative to the AI catheter. Revisions of EVD were needed in 13 cases (22 %) due to CSF infection, dysfunction, impaired healing, or malplacement (p = 0.37). Conclusion Regarding CSF infection rate and dysfunc-tion, no statistical significant differences between the two EVD catheters Bactiseal ® versus VentriGuard ® were found. The silver-bearing catheter might offer a safe and cost-conscious alternative to the AI catheter.

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Section: Discussionsupporting

confidence: 62%

Antibiotic-Impregnated Versus Silver-Bearing External Ventricular Drainage Catheters: Preliminary Results in a Randomized Controlled Trial

et al. 2013

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“…This rate is comparable to previously reported rates for hemorrhagic complication among cohorts for whom routine postprocedural CT images were obtained. 4,13 In our study, 75% of the positive CT findings were either punctate or small foci of hemorrhage (Grades 1 and 2). We did not observe significant increases in EVD-associated hemorrhagic complications among patients who received prophylaxis within 24 hours of their procedure or before their procedure.…”

Section: Discussionmentioning

confidence: 47%

Risks for hemorrhagic complications after placement of external ventricular drains with early chemical prophylaxis against venous thromboembolisms

Tanweer¹,

Boah²,

Huang³

2013

JNS

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Object Patients undergoing placement of an external ventricular drain (EVD) are at increased risk for development of venous thromboembolisms (VTEs). Early chemical prophylaxis has been shown to decrease rates of embolism formation, but the risks for bleeding and the optimal time to initiate prophylaxis have not been clearly defined for this patient population. The authors evaluated the safety and risks for bleeding when chemical prophylaxis for VTEs was started within 24 hours of EVD placement. Methods To compare rates of hemorrhage among patients who received prophylaxis within 24 hours and those who received it later than 24 hours after admission, the authors conducted an institutional review board–approved retrospective review. Patients were those who had had an EVD placed and postprocedural imaging conducted at Bellevue Hospital, New York, from January 2009 through April 2012. Data collected included demographics, diagnosis, coagulation panel results, time to VTE prophylaxis and imaging, and occurrence of VTEs. The EVD-associated hemorrhages were classified as Grade 0, no hemorrhage; Grade 1, petechial hyperdensity near the drain; Grade 2, hematoma of 1–15 ml; Grade 3, epidural or subdural hematoma greater than 15 ml; or Grade 4, intraventricular hemorrhage or hematoma requiring surgical intervention. Results Among 99 patients, 111 EVDs had been placed. Low-dose unfractionated heparin had been given within 24 hours of admission (early prophylaxis) to 56 patients and later than 24 hours after admission (delayed prophylaxis) to 55 patients. There were no statistical differences across all grades (0–4) among those who received early prophylaxis (n = 45, 5, 5, 1, and 0, respectively) and those who received delayed prophylaxis (n = 46, 4, 1, 1, and 3, respectively) (p = 0.731). In the early prophylaxis group, 3 VTEs were discovered among 32 of 56 patients screened for clinically suspected VTEs. In the delayed prophylaxis group, 5 VTEs were discovered among 33 of 55 patients screened for clinically suspected VTEs (p = 0.71). Conclusions Hemorrhagic complications did not increase when chemical prophylaxis was started within 24 hours of admission. Also, the incidence of VTEs did not differ between patients in the early and delayed prophylaxis groups. Larger randomized controlled trials are probably needed to assess decreases in VTEs with earlier prophylaxis.

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“…Interestingly, studies have also suggested that larger catheters may result in smaller hemorrhage volumes compared with smaller catheters, possibly through a tamponade effect. 14,19 Midline shift is a marker of unilateral pressure exerted on an unevenly distributed ventricular system in the setting of elevated intracranial pressure, which could result in ipsilateral ventricular decompression after EVD placement and obstruction of the catheter due to collapsed ventricular ependyma. In addition, this study validates the classic teaching of the FoM as the preferred target for EVD placement.…”

Section: Discussionmentioning

confidence: 99%

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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Hemorrhagic Complications Of External Ventricular Drainage

Cited by 77 publications

References 28 publications

Antibiotic-Impregnated Versus Silver-Bearing External Ventricular Drainage Catheters: Preliminary Results in a Randomized Controlled Trial

Antibiotic-Impregnated Versus Silver-Bearing External Ventricular Drainage Catheters: Preliminary Results in a Randomized Controlled Trial

Risks for hemorrhagic complications after placement of external ventricular drains with early chemical prophylaxis against venous thromboembolisms

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

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