External ventricular drain nursing care pdf bitbin. Care of the patient undergoing intracranial pressure monitoring external ventricular drainage or lumbar drainage. Nursing management of the external ventricular drain the neurosurgeon will write orders for drain level example set drain at 0mmhg, drain hourly, call parameters usually zero csf output for an hour or greater than 30cc in an hour, and for icp readings greater than 20mmhg for more than 5 minutes. External drainage and monitoring is the temporary drainage of cerebrospinal fluid csf from the lateral ventricles of the brain, or the lumbar space of the spine, into an external collection bag. Various types of acquired brain injury, such as intracranial hemorrhage with intraventricular extension, subarachnoid hemorrhage, traumatic brain injury, and bacterial. Ventriclear external ventricular drainage catheters. A tubing connector with a luer connector is provided to facilitate the catheter connection to the drainage system. In this study, we aimed to establish a national eri rate in the uk and ireland and determine key factors influencing the infection risk. It is considered the most accurate icp monitor while allowing for drainage of csf. Extraventricular drainage system and icp monitoring. The insertion and management of external ventricular drains.
Typically, a burr hole is created through a small incision behind the hairline, and the catheter is passed through the brain and into the frontal horn of the lateral ventricle. Patients were followed up for 30 days after catheter removal. An external ventricular drain evd is a temporary catheter that diverts csf from the ventricles to a bedside collection system. External ventricular drain evd placement is a common neurosurgical procedure performed in both the intensive care unit icu and operating room or.
External ventricular drainage evd has its own drawbacks. External ventricular drains evds are commonly placed to monitor intracranial pressure and manage acute hydrocephalus in patients with a variety of intracranial pathologies. Insertion of an external ventricular drain evd is arguably one of the most common and important lifesaving procedures in neurologic intensive care unit. Neuroscience critical care unit, penn state milton s. External ventricular drain evd is a standard approach for both monitoring intracranial pressure icp and draining cerebrospinal fluid csf for patients with subarachnoid hemorrhage. External ventricular drain evd usage in patients with intraventricular hemorrhage ivh is variable in current practice and in clinical trials, and its impact on outcome remains controversial.
Contributed to by volume of brain tissue, csf and blood. External ventricular drains evd are life saving tools used in the neuroscience critical care unit. A temporary device allowing measurement and recording of intracranial pressur. The fluid is produced in the brain ventricles and circulates around the brain and spinal cord, protecting them from injury and supplying brain cells with nutrients. Nurses are responsible for the care of patients who have external ventricular drains. An external ventricular drainage evd system drains csf by using a combination of gravity and intercerebral pressure. Establishment of an external ventricular drain evd best practice guideline.
Setup of the becker external drainage and monitoring. External ventricular drains evds are devices commonly used in neurocritical care. External ventricular drain patient information university hospital. Early ambulation in patients with external ventricular drains. Online nursing programs nursing school notes critical care nursing cardiac nursing medical anatomy emergency medicine nursing tips medical science nursing students. An evd external ventricular drain may be indicated in these cases. External ventricular drainage and neurological critical care. Nursing assessment, icu nursing, nursing tips, nursing documentation, study nursing, nursing cheat sheet, college nursing, nursing school. Various types of acquired brain injury, such as intracranial hemorrhage with intraventricular extension, subarachnoid hemorrhage, traumatic brain injury, and bacterial meningitis, may benefit from evd. Establishment of an external ventricular drain best practice. The quest for a comprehensive, universal standard for external ventricular drain care.
Pubmedcrossref dasic d, hanna sj, bojanic s, kerr rs. External ventricular drain evd placement is standard of care in the management of aneurysmal subarachnoid haemorrhageassociated hydrocephalus asah. A cpp value of 60mmhg is targetedfor traumatic brain injury. An external ventricular drainage evd system drains csf by using a combination of. Accurate and accountable nursing care may have the ability to portend.
Although cns infection rates as high as 27% have been reported in patients undergoing evd placement, highest rates of infection occurred in patients who had an evd in place for an average of 8. Risks of an insertion of external ventricular drain there are risks and complications with this procedure. External ventricular drainage and neurological critical. A temporary system that allows drainage of cerebral spinal fluid csf from the ventricles to an external closed system. Perioperative management of adult patients with external ventricular and lumbar drains guidelines from the society for neuroscience in anesthesiology and critical care snacc task force for developing guidelines for perioperative management of the external ventricular and lumbar drain abhijit vijay lele, m. Determinants of external ventricular drain placement and. Nov 24, 2015 an external ventricular drain, also known as an extraventricular drain or ventriculostomy, is a device used in neurosurgery that relieves elevated intracranial pressure and hydrocephalus when the. This new guideline, nursing care management of the patient undergoing intracranial pressure monitoring external ventricular drainage or lumbar drainage, is based on current evidence and practice standards. A multidisciplinary approach to end external ventricular. We performed a retrospective single center study in order to evaluate the incidence of evdrelated infections and to identify underlying risk factors. Health care industry catheterization health aspects drainage surgical standards drainage, surgical infection infection control medical research medicine, experimental. Editedhow to place an external ventricular drain aka ventriculostomy sequence. This guideline is aimed at rch staff involved in the use and management of evd and icp monitoring.
An external ventricular drain evd is a temporary method that uses gravity to drain cerebrospinal fluid csf out of compartments in the brain, called ventricles, via a thin tube that goes out of the head into a chamber and bag. An understanding of the ventricular system and cerebrospinal fluid production is essential to providing appropriate care to the patient undergoing external ventricular drainage. External ventricular drainage or lumbar drainage boston medical. A brief operative procedure introducing an external ventricular drain is a valuable treatment for increased intracranial pressure. A fluid filled icp monitoring transducer not included can be attached to the red 1016673102. The insertion and management of external ventricular. Scroll down to read the article or download a printfriendly pdf here. Overview of external ventricular drainage and monitoring. Abstract external ventricular drains are lifesaving devices used in. External ventricular drain an overview sciencedirect.
General care of the patient with an evd maintaining security and function 3. The following databases were utilized by each member of the interdisciplinary team to establish a state of the. Prospective, multicentre study of external ventricular. Nursing notes nursing tips vp shunt med surg nursing trauma nurse critical care nursing medical. Health care industry cerebrospinal fluid shunts complications and side effects cross infection care and treatment health aspects prevention risk factors disease transmission evidencebased medicine health care teams immunoglobulins.
Early ambulation in patients with external ventricular. Nicole sunderland, ba, bsn, rn, nancy villanueva, phd, rn, crnp, cnrn, susan pazuchanics, msn, rn, ccrn. An external ventricular drain evd, also known as a ventriculostomy or extraventricular drain, is a device used in neurosurgery to treat hydrocephalus and relieve elevated intracranial pressure when the normal flow of cerebrospinal fluid csf inside the brain is obstructed. Caring for neurosurgical patients with external ventricular drains. The hierarchy of evidence royal childrens hospital. External ventricular drain, evd, ambulation, mobilization, early ambulation introduction prolonged immobility in icu patients can lead to muscle wasting and weakness, longer hospital stays, increased number of days in restraints and hospital acquired infections. The external ventricular drain evd catheter is an alternative method for monitoring and controlling elevated icp. The following databases were utilized by each member of the interdisciplinary team to establish a state of the science on evd management. External ventricular drain an overview sciencedirect topics. A multidisciplinary approach to end external ventricular drain infections in the neurocritical care unit.
Objectives external ventricular drain evd insertion is a common neurosurgical procedure. Infection rate and risk factors associated with infections. Evidencebased management of external ventricular drains. This new guideline, nursing care management of the patient undergoing intracranial pressure monitoringexternal ventricular drainage or lumbar drainage, is based on current evidence and practice standards. Perioperative management of adult patients with external. Normal cpp is about 70 mmhg, but when it is less than 50 mmhg there is metabolic evidence of ischaemia and reduced electrical activity. Evd external ventricular drain is a catheter used to measure icp that also allows external. We systematically searched medline, embase, and the cochrane library. Management of the patient with an evd date revised. Ventriclear ventricular drainage catheter sets are designed for obtaining access to a ventricular cavity of the brain for shortterm use to externally drain fluid for the purpose of relieving elevated intracranial pressure or fluid volume. Current practice uses a clamped method or an open method as method for measuring intracranial pressure icp or draining csf. An external ventricular drain evd is a why is an evd needed.
Patient care maintain external ventricular drain zero at. Liverpool health service icu patient care manual, department of nursing, 2009. An external ventricular drain evd is a temporary drain that drains cerebro spinal fluid csf from the lateral ventricles in the centre of the brain to an external. Results for external ventricular drain 1 10 of 81 sorted by relevance date click export csv or ris to download the entire page or use the checkboxes to select a subset of records to download. Health care industry cerebrospinal fluid shunts complications and side effects cross infection care and treatment health aspects prevention risk factors disease transmission evidencebased medicine health care teams. To describe incidence rates and risk factors associated with external ventricular drain evdrelated infections at a tertiary brazilian teaching hospital. Various types of acquired brain injury, such as intracranial hemorrhage with intraventricular extension, subarachnoid hemorrhage, traumatic brain injury, and bacterial meningitis, may benefit from evd insertion. Progress record pediatric critical care see reverse side for instructions and definitions. Purpose to appropriately manage the patient with an external ventricular drain evd 1. External ventricular drain placement in the intensive care.
Insertion of an external ventricular drain evd is arguably one of the most common and most important lifesaving procedures encountered in the neurologic intensive care unit. The patient cohort consisted of all patients at a major teaching hospital in brazil with an evd during the period 1 april 2007 to 30 june 2008 15 months. External ventricular drain zero on pressure scale must be horizontally level with tragus of the ear drainage bag for csf lateral ventricle csf cerebrospinal. Hepburnsmith m, dynkevich i, spektor m, lord a, czeisler b, lewis a. Role of external ventricular drainage in the management of. Nursing should ensure proper zeroing, placement, sterility, and integrity of the evd collecting system. The optimal setting for evd placement in regard to safety and accuracy of placement is poorly defined. Hydrocephalus is a medical emergency and its treatment involves inserting an external ventricular drain evd into one of the lateral. An evd is a flexible plastic catheter placed by a neurosurgeon or neurointensivist and managed by intensive care unit. Complication rates of external ventricular drain insertion.
The accudrain external csf drainage systems can be used with all of the integra neurosciences ventricular and lumbar catheters. An external ventricular drain, also known as an extraventricular drain or ventriculostomy, is a device used in neurosurgery that relieves elevated intracranial pressure and hydrocephalus when the. Management of the patient with an external ventricular drain. Establishment of an external ventricular drain best practice guideline. Various forms of acute brain injury benefit from the continuous intracranial pressure icp monitoring and cerebrospinal fluid csf diversion provided by an evd. Jan 25, 2011 to describe incidence rates and risk factors associated with external ventricular drain evdrelated infections at a tertiary brazilian teaching hospital. Intracranial pressure monitoringexternal ventricular drainage. This guideline replaces two previous guidelines, care of the patient with intracranial pressure monitoring and care of the patient with a lumbar drain. The quest for a comprehensive, universal standard for evd care problem. Increasing evidence demonstrates the safety and feasibility of early mobilization in. Medtronic, exacta tm external drainage and monitoring system quick reference guide.
External ventricular drain evd assisting with insertion, care of, assisting. Complication rates of external ventricular drain insertion by surgeons of different experience j yuen, w selbi, s muquit, t berei plymouth hospitals nhs trust, uk abstract introduction insertion of external ventricular drain evd is a widely accepted, routinely performed procedure for treatment of hydrocephalus and raised intracranial pressure. Care of the patient undergoing intracranial pressure. Editedhow to place an external ventricular drain aka. Incidence of infection in evd around 10% holloway et al 1996 10. Establishment of an external ventricular drain best. External ventricular drains are lifesaving devices used in neurosurgical patients with hydrocephalus excessive amounts of cerebrospinal fluid. All randomized controlled trials rcts and nonrandomized prospective studies npss related to. The indications for evd insertion and their efficacy in the management of these various conditions have been previously addressed in guidelines published by the brain trauma foundation, american heart association and. Nov 09, 2017 25 may 2015 insertion of an external ventricular drain evd is arguably one of the most accurate and accountable nursing care may have the ability to external ventricular drains and intracranial pressure monitoring of each shift it is the responsibility of the nurse rn caring for a patient with an evd to complete. This procedure is performed to insert an external ventricular drain into the brain for the management of excess fluid or increased pressure on the brain.
Adequate trending of intracranial pressure using the openmonitor method. The objective of this study was to identify the clinical predictors of evd utilization, and associated outcome in adults with spontaneous ivh with or without intracerebral hemorrhage ich. Evd, externalized ventricular drains, evd infections, evd insertion, evd care and maintenance, nursing and evds. The goal of care is to prevent the secondary brain injury that results from increased icp. External ventricular drainage evd is frequently used in neurosurgery to drain cerebrospinal fluid in patients with raised intracranial pressure. The procedure to place drain may be performed at the bedside under sterile conditions or in the or.