Ventriculostomy and Infection: A 4-year-review in a local hospital

Tse, Tak Sun; Cheng, KF; Wong, Kam-Fai; Pang, K.H.; Wong, CK

doi:10.4103/2152-7806.69033

Cited by 18 publications

(14 citation statements)

References 13 publications

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confidence: 99%

“…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. 18 Studies 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.…”

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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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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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“…La frecuencia hallada (20%) es considerable pues los reportes de diversos autores oscila entre 0% y (2,3,4,9,11,(17)(18)(19)(20) …”

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“…Los que tuvieron menor tiempo fue por desenlace fatal, colocación precoz de válvula de derivación ventriculoperitoneal o retiro tras cumplir su función. Se encontró que los pacientes que desarrollaron ventriculitis tenían más de 7 días de CDVE, mientras los que tuvieron menos de 7 días no presentaron signos de infección (2,9,12,19) (p 0,01). Este resultado es comparable con otros estudios .…”

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“…Sin embargo no está exenta de hemorragia intracerebral o subaracnoidea), b) factores vinculados a los procedimientos neuroquirúrgicos propiamente dichos, dentro de los cuales se encuentran los propios catéteres intracraneanos (por ejemplo, lugar de emplazamiento, tiempo de permanencia, fístula de LCR (7)(8)(9) asociada, tipo de cirugía, etcétera) . Es indispensable reconocer estos factores para elaborar protocolos de manejo con el fin de disminuir la incidencia de infecciones del LCR.…”

Section: Introductionunclassified

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External ventricular drainage-related ventriculitis

Martínez

Aveiro

2017

Rev. virtual Soc. Parag. Med. Int

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External ventricular drainage-related ventriculitis ARTÍCULO ORIGINAL ARTÍCULO ORIGINALRev. virtual Soc. Parag. Med. Int. marzo 2017; 4 (1):46-56 RESUMENIntroducción: el drenaje ventricular externo es una herramienta útil en el manejo de muchos pacientes neurocríticos. Sin embargo este dispositivo no está exento de complicaciones. La ventriculitis es la más importante complicación infecciosa asociada.Objetivos: determinar la prevalencia de ventriculitis en pacientes adultos con drenaje ventricular externo del Hospital Nacional, describir los factores de riesgo asociados e identificar gérmenes más frecuentemente aislados.Resultados: se incluyeron 92 pacientes con drenaje ventricular externo de los cuales el 20% desarrolló ventriculitis. La totalidad de los pacientes con ventriculitis presentaron síntomas de infección luego de 7 días de instalación del drenaje, además la mitad de los mismos requirieron recambio del catéter lo cual constituyó factor de riesgo. Los gérmenes aislados más frecuentes fueron Staphylococcus epidermidis y Acinetobacter baumanii.Conclusiones: la ventriculitis asociada a catéter de drenaje ventricular externo fue 20%. El factor de riesgo estadísticamente asociado fue el recambio del catéter. Los gérmenes aislados más frecuentes fueron Staphylococcus epidermidis y Acinetobacter baumanii. Palabras claves: ventriculitis, ventriculostomía, infección ABSTRACTIntroduction: External ventricular drainage is a useful tool in the handling of neurocritical patients. However, this device is not free from complications. Ventriculitis is the most important related complication. Objectives:To determine the prevalence of ventriculitis in adult patients with external ventricular drainage of the National Hospital, to describe the associated risk factors and to identify the most frequently isolated microorganisms. Doi:10.18004/rvspmi/ 2017.04(01) Ventriculitis asociada a drenaje ventricular externoResults: Ninety two patients with external ventricular drainage were included and 20% developed ventriculitis. All patients with ventriculitis presented symptoms of infection seven days after drainage installation and half of them required a change of the catheter which was a risk factor. The most frequent isolated microorganisms were Staphylococcus epidermidis and Acinetobacter baumanii. Conclusions:The prevalence of ventriculitis related to the external ventricular drainage catheter was 20%. The statistically associated risk factor was the change of catheter. The most frequent isolated microorganisms were Staphylococcus epidermidis and Acinetobacter baumanii. Keywords: ventriculitis, ventriculostomy, infection INTRODUCCIÓNLa infección relacionada al drenaje ventricular externo es una complicación que puede presentarse en los pacientes sometidos a ventriculostomía hasta en un 39% según algunas (1)(2)(3)(4) publicaciones . Ésta presenta una tasa de mortalidad y morbilidad variable, que complica la evolución de los pacientes con patologías neuroquirúrgicas, prolonga la estancia hospitalaria y los costes asiste...

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Intracranial Pressure and SvjO2

Algarra

Souter

2013

Monitoring Technologies in Acute Care Environments

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Ventriculostomy and Infection: A 4-year-review in a local hospital

Cited by 18 publications

References 13 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

External ventricular drainage-related ventriculitis

Intracranial Pressure and SvjO2

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