Posts Tagged ‘External ventricular drain’
Ahead of Print: A Simple Protocol to Prevent External Ventricular Drain Infections
Background: External ventricular drains (EVDs) are associated with high rates of infection, and EVD infections cause substantial morbidity and mortality.
Objective: We set out to determine whether introduction of an evidence-based EVD Infection Control protocol could reduce the rate of EVD infections.
Methods: This was a retrospective analysis of an EVD Infection Control protocol introduced in a tertiary care Neuro-ICU. We compared rates of cerebrospinal fluid (CSF) culture positivity and ventriculitis for the three years before and three years after the introduction of an evidence-based EVD Infection Control protocol. A total of 262 EVD placements were analyzed, with a total of 2,499 catheter-days.
Ahead of Print: EVD-Related Vascular Injury
Background: Placement of an external ventricular drain (EVD) is a commonly performed and often life-saving procedure. Although hemorrhage is one of the most common complications associated with the procedure, ventricular catheter-induced vascular injury is rarely reported.
Objective: We describe 9 cases of EVD-related vascular trauma: 7 arteriovenous fistulae and 2 traumatic aneurysms.
Methods: During a 3-year period, 299 patients had EVDs placed. Eight patients (2.75%), 3 male and 5 female, mean age 48 +/- 20 years, developed vascular lesions associated with EVDs. Six patients developed arteriovenous fistulae (AVFs) and 2 patients developed a traumatic aneurysm. The arterial feeders of five superficial draining fistulae arose from the middle meningeal artery, and the arterial feeder of a deep draining fistula originated from a lenticulostriate artery. One traumatic aneurysm arose from a distal branch of the anterior cerebral artery, and the second from a branch of the superficial temporal artery. Four of the superficial fistulae were treated with transarterial embolization.
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.
Ahead of Print: Catheter Placement and Clearance of IVH
Background: There is no consensus regarding optimal position of external ventricular drain (EVD) with regard to clearance of intraventricular hemorrhage (IVH).
Objective: To assess the hypothesis that EVD laterality may influence the clearance of blood from the ventricular system, with and without administration of thrombolytic agent.
Methods: The EVD location was assessed in 100 patients in two CLEAR Phase II trials assessing the safety, and dose optimization of thrombolysis through the EVD to accelerate the clearance of obstructive IVH. Laterality of catheter was correlated with clearance rates.
