How do evd drains work

Lumbar drainage devices Lumbar drains can be indicated for insertion to assist with CSF leaks, evaluate the effect of reduced CSF pressure or as a temporary external shunt. References Adelson. Intracranial pressure monitoring. Paediatric Critical Care, 4 3 suppl. Hepburn-Smith, M.

The Journal of neuroscience nursing: journal of the American Association of Neuroscience Nurses, 48 1 , 54— Caring for neurosurgical patients with external ventricular drains. Nursing Times, 4 Institute for healthcare Improvement. Lewis, A. The Neurohospitalist, 7 1 , Doi: Medtronic, exacta TM external drainage and monitoring system quick reference guide.

Medtronic Inc. Muralidharan R. External ventricular drains: Management and complications. Surgical neurology international, 6 Suppl 6 , S—S Intracranial pressure monitoring: Gold standard and recent innovations. World journal of clinical cases, 7 13 , — Great Ormand Street Hospital.

External Ventricular Drainage. Qalab, A. Paediatric external ventricular drains: experience from a tertiary care hospital of a developing country. External ventricular device guideline EVD. Policies and Procedures; Skin and surgical antisepsis. Complications of invasive intracranial pressure monitoring devices in neurocritical care. Neurosurgical focus, 43 5 , E6. Pediatric Neurosurgery, 36 1 , 22— If drainage exceeds reportable limits the Neurosurgeon must be contacted as the risk of excessive drainage can lead to collapsed ventricles, subdural haemorrhage or in some cases upward herniation.

If the patient has visible clear fluid on or around the entry site, this must be reported to the AUM and Neurosurgeon. Turn monitor on and ensure appropriate ICP cords and transducer box are available. Set appropriate alarm limits including ICP limits. Load paper for printing of ICP, located at the right-hand side of the monitor.

Printing should commence at this point. Check alarm is turned on via main menu. Wash your hands and ensure a non-touch technique. Remove a cap white or yellow to open the transducer to the atmosphere.

The screen should say ICP zeroed, followed by the time and date. Ensure appropriate alarm limits are set. As with any foreign body potential for infection is possible.

Management of the patient with an external ventricular drain requires constant assessment and intervention. Attention Physicians! Not all indications stated are cleared in all geographies. Unfortunately, he is not currently available as he is scrubbed in theatre. Most guidelines currently recommend that the arterial transducer is set at approximately the level of the foramen of Monro which is considered to be approximately the level of the external auditory meatus or the level of the tragus rather than the phlebostatic axis heart level to enable more accurate calculation of CPP.

The transducer position should be change to remain at the level of the tragus regardless of patient position. Individual differences in cerebral arterial and venous circulations mean that it not possible to determine a coefficient C that accurately takes this into account if the transducer is left at the phlebostatic axis. The level of the ventricles is estimated to provide the zero point.

The difference in height between the ventricles and the collection system chamber creates both a pressure gradient and a safety valve. The height of the drip chamber equates to the pressure inside of the head or intracranial pressure ICP. This pressure must be reached before any CSF will drain into the collection system. Accurate placement and zeroing of the system is important. For example, if the transducer is above Foramen of Monro, falsely low ICP and insufficient drainage of CSF may occur, and intracranial hypertension would go undetected.

EVD-related infections include: ventriculitis, meningitis, cerebritis, brain abscess and subdural empyema. It diverts fluid away from the operation site, which allows the wound to heal without the risk of CSF leaking out. The drain will be inserted in an operation under general anaesthetic, lasting between one and two hours. Where possible, the surgeon will discuss the exit site with you before the operation.

Before the operation, the surgeon will visit you to explain the operation in more detail, discuss any worries you may have and ask you to sign a consent form giving permission for your child to have the operation. If your child has any medical problems, like allergies, please tell the doctors about these. Healthy children usually cope well with the anaesthetic, but the risk increases if your child has other problems. There is a risk of infection with EVD but this will be minimised by using gloves and sterile equipment whenever a nurse or doctor has to open the system.

Your child will return to the ward to recover from the anaesthetic. They will have a light dressing where the catheter was inserted, and another light dressing on the exit site. The nurses will set up the drainage system and explain in detail how it works.

Please do not try to set it up yourself. While your child is having EVD, the nurses will be monitoring them closely. If too much CSF drains away, your child will become pale and clammy, may vomit and could become sleepy.