Safety, Accuracy, and Cost Effectiveness of Bedside Bolt External Ventricular Drains (EVDs) in Comparison with Tunneled EVDs Inserted in Theaters

Roach, Joy; Gaastra, Ben; Bulters, Diederik; Shtaya, Anan

doi:10.1016/j.wneu.2019.01.106

Cited by 23 publications

(16 citation statements)

References 15 publications

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“…Bolt EVDs are gaining increasing acceptance over the traditional burr-hole technique among both the neurosurgical and neuro-intensive care communities. This is following a number of reports over the past years that have demonstrated their more favourable rate of procedure-related complications [2,3,17] (or, at the least, comparable to that of traditional external ventriculostomy [16,12]). Furthermore, bolt EVDs placed in ICU impart a non-measurable logistical and medical advantage by avoiding transfer of potentially unstable patients to the operating theatre.…”

Section: (1) Bolt Evd Insertion In Icumentioning

confidence: 68%

“…The design of cranial rapid access kits and bolt external ventricular drains (EVD) has responded to the clinical demand for rapid cranial cerebrospinal fluid (CSF) diversion in patients with time critical indications to CSF drainage or who are too unstable for safe transfers between ICU, the CT scanner and the operating theatre. Their use in the intensive care unit (ICU) [16] is further supported by their favourable CSF infection and leakage rates [17,2], their decreased rate of pull-out [3], and their cost-effectiveness [16].…”

Section: Introductionmentioning

confidence: 99%

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Neuronavigation-assisted bedside placement of bolt external ventricular drains in the intensive care setting: a technical note

et al. 2020

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Background: The insertion of bolt external ventricular drains (EVD) on the intensive care unit (ICU) has enabled rapid cranial cerebrospinal fluid (CSF) diversion. However, bolt EVDs tend to be perceived as a more challenging technique, particularly when dealing with small ventricles or when there is midline shift distorting the ventricular morphology. Furthermore, if neuronavigation guidance is felt to be necessary, this usually assumes a transfer to an operating theatre. In this technical note, we describe the use of electromagnetic neuronavigation for bolt EVD insertion on the ICU and assess the protocol's feasibility and accuracy.Methods: Case series of neuronavigation-assisted bolt EVD insertion in ICU setting, using Medtronic Flat Emitter for StealthStation EM.Results: Neuronavigation-guided bolt EVDs were placed at the bedside in n=5 patients on ICU. Their widest frontal ventricular horn diameter in the coronal plane ranged from 11 to 20 mm. No procedural complications were encountered. Post-procedural CT confirmed the optimal placement of the EVDs.Conclusions: Electromagnetic neuronavigation is feasible at the ICU bedside and can assist the insertion of bolt EVDs in this setting. The preference for a bolt EVD to be inserted in ICU -as is standard practice at this unitshould not prohibit patients from benefitting from image guidance if required.

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Section: (1) Bolt Evd Insertion In Icumentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Neuronavigation-assisted bedside placement of bolt external ventricular drains in the intensive care setting: a technical note

et al. 2020

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“…[5] e number of unsatisfactory installation of EVD can reach 39% when using free hand technology. [6] In 1973, the experience of using the Gajar guide was published to improve the accuracy of the EVD installation. [7] Since then, the literature has described a variety of mechanical and electronic devices capable of improving the accuracy of the direction of the EVD.…”

Section: Discussionmentioning

confidence: 99%

Neuronavigation device for stereotaxic external ventricular drainage insertion

Konovalov

Okishev

Shekhtman

et al. 2021

Surgical Neurology International

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Background: The insertion of an external ventricular drainage (EVD) is one of the most frequently used neurosurgical procedures. It is performed to adjust intracranial hypertension in cases of severe craniocerebral injury, acute posthemorrhagic hydrocephalus, meningitis, and oncological diseases related to impaired circulation of cerebrospinal fluid circulation (CSF). Methods: In 2020, three patients with subarachnoid aneurysmal hemorrhage underwent insertion of an EVD navigation percutaneous stereotaxic device. Three cases introduced. Results: In all cases, satisfactory EVD functioning was noted during the surgery and during the early postoperative period. The EVD insertion procedure took an average of 10 min. The EVD insertion route calculations using the software took about 5–15 min. No cases showed any infection, hemorrhagic complications, or EVD dysfunction. According to the control brain computed tomography data, the catheter position was satisfactory and corresponded to the target coordinates in all cases. Conclusion: The use of the device, with its high accuracy and efficiency, can reduce the incidence of unsatisfactory EVD implantation cases in patients with neurosurgical pathology.

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“…Bolt EVDs are secured with a bolt, therefore obviating the need for tunnelling [96]. This has some theoretical advantages, such as lower risk of CSF leak, infection, and catheter migration [97].…”

Section: Literature Reviewmentioning

confidence: 99%

“…The low number of included EVDs may explain the lack of statistical significance for this complication type. Nonetheless, there are large retrospective studies demonstrating their accuracy, safety, and cost effectiveness [96,97,98,99]. This is a potentially promising technology to reduce the risk of complications, but ultimately, randomised trials will be needed to reach robust conclusions.…”

Section: Literature Reviewmentioning

confidence: 99%

The Evolution of the Role of External Ventricular Drainage in Traumatic Brain Injury

Chau

Craven

Rubiano

et al. 2019

JCM

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External ventricular drains (EVDs) are commonly used in neurosurgery in different conditions but frequently in the management of traumatic brain injury (TBI) to monitor and/or control intracranial pressure (ICP) by diverting cerebrospinal fluid (CSF). Their clinical effectiveness, when used as a therapeutic ICP-lowering procedure in contemporary practice, remains unclear. No consensus has been reached regarding the drainage strategy and optimal timing of insertion. We review the literature on EVDs in the setting of TBI, discussing its clinical indications, surgical technique, complications, clinical outcomes, and economic considerations.

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Safety, Accuracy, and Cost Effectiveness of Bedside Bolt External Ventricular Drains (EVDs) in Comparison with Tunneled EVDs Inserted in Theaters

Abstract: This study was completed with lack of dedicated funding. We acknowledge NIHR lectureship to Mr Shtaya.

Cited by 23 publications

References 15 publications

Neuronavigation-assisted bedside placement of bolt external ventricular drains in the intensive care setting: a technical note

Neuronavigation-assisted bedside placement of bolt external ventricular drains in the intensive care setting: a technical note

Neuronavigation device for stereotaxic external ventricular drainage insertion

The Evolution of the Role of External Ventricular Drainage in Traumatic Brain Injury

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