NEUROSURGERY Report

Daily news and updates provided by the NEUROSURGERY® Editorial Office

Posts Tagged ‘Catheter

Ahead of Print: Silver-Impregnated Line Vs EVD Randomized Trial

Background: Cerebrospinal fluid (CSF) infections associated with external ventricular drain (EVD) placement attract major consequences. Silver impregnation of catheters attempts to reduce infection.

Objective: To assess the efficacy of silver catheters against CSF infection.

Methods: We performed a randomized controlled trial involving two neurosurgical centers (June 2005 to September 2009). 356 patients requiring an EVD were assessed for eligibility; 325 patients were enrolled and randomized (167 plain, 158 silver). 278 patients were analyzed (140 plain, 138 silver). The primary outcome measure was CSF infection as defined by organisms seen on gram stain or isolated by culture. Secondary outcome measures included ventriculo-peritoneal (VP) shunting.

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Written by NEUROSURGERY® Editorial Office

June 7, 2012 at 8:01 AM

Ahead of Print: Ventricular Catheter Obstruction in Hydrocephalus

The treatment of hydrocephalus by cerebrospinal fluid (CSF) shunting is plagued by ventricular catheter obstruction.Shunts can become obstructed by cells originating from tissue normal to the brain or by pathological cells in the CSF for a variety of reasons.In this review, the authors examine ventricular catheter obstruction and identify some of the modifications to the ventricular catheter that may alter the mechanical and chemical cues involved in obstruction, including alterations to the surgical strategy, modifications to the chemical surface of the catheter, and changes to the catheter architecture.It is likely a combination of catheter modifications that will improve the treatment of hydrocephalus by prolonging the life of ventricular catheters to improve patient outcome.

From: What We Should Know About the Cellular and Tissue Response Causing Catheter Obstruction in the Treatment of Hydrocephalus by Harris et al.

Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.

Written by NEUROSURGERY® Editorial Office

March 16, 2012 at 8:00 AM

Editor Choice: Impact of a Standardized Protocol and Antibiotic-Impregnated Catheters on Ventriculostomy Infection Rates in Cerebrovascular Patients

Full article access for Neurosurgery subscribers.

Harrop, James S. MD; Sharan, Ashwini D. MD; Ratliff, John MD; Prasad, Srini MD; Jabbour, Pascal MD; Evans, James J. MD; Veznedaroglu, Erol MD; Andrews, David W. MD; Maltenfort, Mitchell PhD; Liebman, Kenneth MD; Flomenberg, Phyllis MD; Sell, Bevin MD; Baranoski, Amy S. MD; Fonshell, Claudette RN; Reiter, David MD; Rosenwasser, Robert H. MD

BACKGROUND: Ventriculostomy infections create significant morbidity. To reduce infection rates, a standardized evidence-based catheter insertion protocol was implemented. A prospective observational study analyzed the effects of this protocol alone and with antibiotic-impregnated ventriculostomy catheters.

OBJECTIVE: To compare infection rates after implementing a standardized protocol for ventriculostomy catheter insertion with and without the use of antibiotic-impregnated catheters.

METHODS: Between 2003 and 2008, 1961 ventriculostomies and infections were documented. A ventriculostomy infection was defined as 2 positive CSF cultures from ventriculostomy catheters with a concurrent increase in cerebrospinal fluid white blood cell count. A baseline (preprotocol) infection rate was established (period 1). Infection rates were monitored after adoption of the standardized protocol (period 2), institution of antibiotic-impregnated catheter A (period 3), discontinuation of antibiotic-impregnated catheter A (period 4), and institution of antibiotic-impregnated catheter B (period 5).

RESULTS: The baseline infection rate (period 1) was 6.7% (22/327 devices). Standardized protocol (period 2) implementation did not change the infection rate (8.2%; 23/281 devices). Introduction of catheter A (period 3) reduced infections to 1.0% (2/195 devices, P = .0005). Because of technical difficulties, this catheter was discontinued (period 4), resulting in an increase in infection rate (7.6%; 12/157 devices). Catheter B (period 5) significantly decreased infections to 0.9% (9 of 1001 devices, P = .0001). The Staphylococcusinfection rate for periods 1, 2, and 4 was 6.1% (47/765) compared with 0.2% (1/577) during use of antibiotic-impregnated catheters (periods 3 and 5).

CONCLUSIONS: The use of antibiotic-impregnated catheters resulted in a significant reduction of ventriculostomy infections and is recommended in the adult neurosurgical population.

Full article access for Neurosurgery subscribers.

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Written by NEUROSURGERY® Editorial Office

July 2, 2010 at 9:00 AM

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