External Ventricular Drain Placement, Management And Nursing Care: What The Guidelines Recommend?

Year 2020, Volume: 24 Issue: 3, 209 - 216, 01.01.2021

Gülay Öztürk , Türkan Özbayır

Abstract

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. However the most common complication of EVD is that of EVD-related infection. EVD-related infections increase morbidity, mortality, length of hospital stay, and costs; require prolonged courses of antibiotics; and increase the need for subsequent permanent cerebrospinal fluid (CSF) diversion using an internalized shunt system, such as a ventriculoperitoneal shunt. Because of this reason guides for EVD management have been established. In general, in these guides; the environment in which the catheter is placed, aseptic technique and skin preparation, catheter selection, prophylactic antibiotics, use of protocol, frequency of CSF sampling, catheterization duration and exchange, venous thromboembolism (VTE) prophylaxis, dressing type and changes and EVD care. Nurses involved in caring for patients with EVD must be knowledgeable and should ensure that the care given is based on the best available evidence. In this review; external ventricular drain placement, management and nursing care has been handled in line with the recommendations of the guides, and current approaches have been presented.

Keywords

External ventricular drain, nursing care, guideline recommendations

Eksternal Ventriküler Drenaj Takılması, Yönetimi ve Hemşirelik Bakımı: Rehberler Ne Diyor?

Abstract

Eksternal ventriküler drenaj (EVD) takılması, nöroşirürji yoğun bakım ünitesinde karşılaşılan en yaygın ve en önemli hayat kurtarıcı prosedürlerden biridir. Bununla birlikte EVD ile ilişkili enfeksiyon en sık görülen EVD komplikasyonudur. EVD ile ilişkili enfeksiyonlar; morbidite, mortalite, hastanede kalış süresi ve maliyeti arttırır, uzun süreli antibiyotik kullanımı gerektirir ve ventriküloperitoneal şant gibi kalıcı beyin omurilik sıvısı (BOS) drenajı ihtiyacını arttırır. Bu nedenle EVD yönetimi için rehberler oluşturulmuştur. Genel olarak bu rehberlerde; EVD kateter takıldığı ortam, aseptik teknik ve cilt hazırlığı, kateter seçimi, profilaktik antibiyotik kullanımı, protokol kullanımı, BOS örnekleme sıklığı, kateterizasyon süresi ve değişimi, venöz tromboemboli (VTE) profilaksisi, pansuman tipi ve değişimi ve EVD bakımı ile ilgili öneriler yer almaktadır. EVD’li hastalara bakım veren hemşireler yeterli bilgi düzeyine sahip olmalı ve verilen bakımın mevcut en iyi kanıtlara dayanmasını sağlamalıdır. Bu derlemede; EVD takılması, yönetimi ve hemşirelik bakımı rehberlerin önerileri doğrultusunda ele alınarak güncel yaklaşımlar sunulmuştur.

Keywords

Eksternal ventriküler drenaj, hemşirelik bakımı, rehber önerileri

References

• Gardner PA, Engh, J, Atteberry D, Moossy JJ. Hemorrhage rates after external ventricular drain placement. Journal of Neurosurgery 2009;110(5):1021-1025. doi: 10.3171/2008.9.JNS17661.
• Muralidharan, R. External ventricular drains: Management and complications. Surg Neurol Int 2015;6:271-274. doi: 10.4103/2152-7806.157620.
• Dasgupta D, D’Antona L, Cat DA, Toma AK, Curtis C, Watkins LD, et al. Simulation workshops as an adjunct to perioperative care bundles in the management of external ventricular drains:improving surgical technique and reducing infection. J Neurosurg 2018:1-5. doi: 10.3171/2018.5.JNS172881.
• Sorinola A, Buki A, Sandor J, Czeiter E. Risk factors of external ventricular drain infection: proposing a model for future studies. Frontiers in Neurology 2019;10 (226):1-8. doi: 10.3389/fneur.2019.00226.
• Lo CH, Spelman D, Bailey M, Cooper DJ, Rosenfeld JV, Brecknell JE. External ventricular drain infections are independent of drain duration: an argument against elective revision. Journal of Neurosurgery 2007;106(3):378-383. doi: 10.3171/jns.2007.106.3.378.
• Talibi SS, Silva AH, Afshari FT, Hodson J, Roberts SA, Oppenheim B, et al. The implementation of an external ventricular drain care bundle to reduce infection rates. British Journal of Neurosurgery 2020:1-6. doi: 10.1080/02688697.2020.1725436.
• Lozier AP, Sciacca RR, Romagnoli MF, Connolly E, Sander J. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery 2002;51:170-182. doi:10.1097/00006123-200207000-00024.
• Toma AK, Camp S, Watkins LD, Grieve J, Kitchen ND. External ventricular drain insertion accuracy: Is there a need for change in practice?. Neurosurgery 2009;65(6):1197-1201. doi: 10.1227/01.NEU.0000356973.39913.0B.
• Woodward S, Addison C, Shah S, Brennan F, MacLeod A, Clements M. Benchmarking best practice for external ventricular drainage. British Journal of Nursing 2002;11(1):47-53. doi: 10.12968/bjon.2002.11.1.12217.
• 1American Association of Neuroscience Nurses. (2011). Care of the patient undergoing intracranial pressure monitoring/external ventricular drainage or lumbar drainage. https://www.bmc.org/sites/default/files/Patient_Care/Specialty_Care/Stroke_and_Cerebrovascular_Center/Medical_Professionals/Protocols/AANN%20Guideline%20caring%20for%20ICP%20Monitor%20External%20Vent%20Drain%20or%20Lumbar%20Drainage.pdf. Erişim tarihi: 10.06.2020.
• Fried HI, Nathan BR, Rowe AS, Zabramski JM, Andaluz N, Bhimraj A,et al. The ınsertion and management of external ventricular drains: an evidence-based consensus statement. Neurocritical Care 2016;24(1):61-81. doi:10.1007/s12028-015-0224-8.
• Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Scheld WM, et al. 2017 Infectious diseases society of america’s clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clinical Infectious Diseases 2017;64(6):e34-e65. doi: 10.1093/cid/ciw861.
• Enriquez-Marulanda A, Ascanio LC, Salem MM, Maragkos GA, Jhun R, Alturki AY, et al. Accuracy and safety of external ventricular drain placement by physician assistants and nurse practitioners in aneurysmal acute subarachnoid hemorrhage. Neurocritical Care 2018;29:435-442. doi: 10.1007/s12028-018-0556-2.
• Centers for Disease Control. (2020). Central line insertion practices (CLIP) adherence monitoring. https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf. Erişim tarihi:15.06.2020.
• Dorresteijn KRIS, Brouwer MC, Jellema K, van de Beek D. Bacterial external ventricular catheter-associated infection. Expert Review of Anti-Infective Therapy 2020:1-11. doi: 10.1080/14787210.2020.1717949.
• Atkinson RA, Fikrey L, Vail A, Patel HC. Silver-impregnated external-ventricular-drain-related cerebrospinal fluid infections: a meta-analysis. Journal of Hospital Infection 2016;92(3):263-272. doi: 10.1016/j.jhin.2015.09.014.
• Whyte C, Alhasani H, Caplan R,Tully AP. Impact of an external ventricular drain bundle and limited duration antibiotic prophylaxis on drain-related infections and antibiotic resistance. Clinical Neurology and Neurosurgery 2020;190:105641. doi: 10.1016/j.clineuro.2019.105641.
• Hill M, Baker G, Carter D, Henman LJ, Marshall K, Mohn K, et al. A multidisciplinary approach to end external ventricular drain infections in the neurocritical care unit. Journal of Neuroscience Nursing 2012;44(4):188-193. doi:10.1097/JNN.0b013e3182527672.
• Kubilay Z, Amini S, Fauerbach LL, Archibald L, Friedman WA, Layon AJ. Decreasing ventricular infections through the use of a ventriculostomy placement bundle: Experience at a single institution. Journal of Neurosurgery 2013;118(3):514-520. doi:10.3171/2012.11.JNS121336.
• Van de Beek D, Drake JM, Tunkel AR. Nosocomial bacterial meningitis. New England Journal of Medicine 2010;362(2):146-154. doi: 10.1056/NEJMra0804573.
• Zheng WJ, Li LM, Hu ZH, Liao W, Lin QC, Zhu YH, et al. Bilateral external ventricular drains ıncrease ventriculostomy-associated cerebrospinal fluid ınfection in low modified graeb score ıntraventricular hemorrhage. World Neurosurgery 2018;116:e550-e555. doi: 10.1016/j.wneu.2018.05.030.
• Tanweer O, Boah A, Huang PP. Risks for hemorrhagic complications after placement of external ventricular drains with early chemical prophylaxis against venous thromboembolisms. Journal of Neurosurgery 2013;119(5):1309-1313. doi: 10.3171/2013.7.JNS13313.
• Scheithauer S, Möller M, Höllig A, Marx G, Thoröe S, Lopez-Gonzalez L, et al. Are chlorhexidine-containing dressings safe for use with ventricular drainages? Infection 2014;42(3):545-548. doi:10.1007/s15010-014-0596-2.
• Trick WE, Kioski CM, Howard KM, Cage GD, Tokars JI, Yen BM, et al. Outbreak of pseudomonas aeruginosa ventriculitis among patients in a neurosurgical ıntensive care unit. Infection Control & Hospital Epidemiology 2000;21(03):204-208. doi: 10.1086/501745.
• Chung DY, Olson DM, John S, Mohamed W, Kumar MA, Thompson BB, et al. Evidence-based management of external ventricular drains. Current Neurology and Neuroscience Reports 2019;19(12). doi: 10.1007/s11910-019-1009-9.