External ventricular drain Medical Presentation

External Ventricular Drain PowerPoint Presentation

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Published on : Jul 02, 2019 | Views : 5997 | Downloads : 50

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External Ventricular Drain Presented By: Pratima Dulal
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Also known as a ventriculostomy or extraventricular drain 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. Diverts fluid from the ventricles of the brain and allow for monitoring of intracranial pressure. Fig: External Ventricular Drainage System
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Relieve elevated intracranial pressure (ICP) Drain infected CSF Drain bloody CSF or blood after surgery or hemorrhage Monitor the flow rate of CSF
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The patient is maintained with head of bed elevated at 45 degrees in the supine position. Hair is removed using clippers and the scalp is prepared in a sterile fashion. The EVD catheter is most frequently placed by way of a twist-drill craniostomy placed at Kocher's point. The catheter tip is placed in the frontal horn of the lateral ventricle or in the third ventricle. The catheter is typically inserted on the right side of the brain, but in some cases a left-sided approach is used, and in other situations catheters are needed on both sides.
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The initial height of the collecting system is set “high” such that CSF is not drained too quickly When positioning an EVD, the height of the EVD must be in line with the Foramen of Monro. The drip chamber is adjusted to the desired height level, before unclamping the chamber. Flow ceases once the pressure equalizes between the CSF compartments in the brain and collection system, so the collection system must be re-leveled whenever the patient changes position to avoid erroneous ICP reading and/or over or under drainage. If an EVD is open with continuous drainage, the stopcock at the level of the transducer should be turned “off” to the drain and “open” to the transducer in order to obtain an ICP reading.
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Always ensure that the dressing to the EVD is intact, the insertion site should be clean and covered with clear occlusive dressing. Always level the transducer and drainage chamber at the beginning of each shift and if the patient’s position in the bed alters. Vital signs and neurological observations including the Glasgow Coma Score must be recorded hourly. ICP and CPP are charted hourly Document amount of drainage from EVD or lumbar CSF drain hourly and note the colour. If there has been no drainage from the drain for one hour when there has previously been drainage or there is an increase in ICP check that there are no clamps on and that the stopcocks are not turned off If there is a device error then contact the ICU registrar. The neurosurgical registrar should be contacted if there are any ongoing concerns about patency of the drain When the decision to remove the drain has been documented and a medical officer is available to insert a suture, only then can the nurse remove the EVD.
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Check and document, weather: EVD drainage point is set at the prescribed level EVD column is oscillating and patent ICP waveform is pulsatile on monitor Head dressing is dry and intact Caution mentioned below should be taken to prevent undesired consequences: Sterile technique should be followed to prevent infection Drainage should be monitored hourly to check for possible blockage Following the sterile technique, Heparin and Urokiness are administered according to order to prevent blockage Drain bag must be kept straight and placed from the pinna of ear
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Bleeding Mechanical Infection Neurological Bleeding Bleeding can occur along the EVD insertion tract or in the several layers of the meninges that prohibit passage into the brain. If drilling or dural puncture is not successful, the surgeon may dissect away dura and create a secondary bleed known as an epidural or subdural hemorrhage. Bleeding from EVD placement can be life-threatening and can require neurosurgical intervention in some cases. The risk of hemorrhage with EVD placement is increased if the patient suffers from coagulopathy
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Categorise: Malplacement If the EVD is not placed with the tip of the catheter in the lateral or third ventricle, it is considered malplaced. If the catheter crosses critical brain regions such as the internal capsule or the upper brainstem, malplacement can be symptomatic. Obstruction Fibrinous/clot like material or kinking of the tube causes obsturction. The brain can swell due to pressure build up in the ventricles and permanent brain damage can occur. Migration EVD can dislodge or migrate. The tip of the drain migrates away from its intended position and provide inaccurate ICP measurement or lead to occlusion of the drain.
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EVD is a potential entry point for serious infection. Historically, the rate of infections associated with EVDs has been very high, ranging from 5% to >20%. Infections associated with EVDs can progress to become a severe form of brain infection known as ventriculitis. Protocols designed to reduce the rate of EVD infections have been successful, applying infection control 'bundle' approaches to reduce the rate of infection to well less than 1%.
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There can be an association of a patient's poor neurological status with EVD malplacement. The EVD inserted too deep can cause coma due to irritation of the recticular activating system.
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