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Establishment of an External Ventricular Drain Best Practice Guideline: The Quest for a Comprehensive, Universal Standard for External Ventricular Drain Care

Hepburn-Smith, Millie; Dynkevich, Irina; Spektor, Marina; Lord, Aaron; Czeisler, Barry; Lewis, Ariane

Journal of Neuroscience Nursing: February 2016 - Volume 48 - Issue 1 - p 54–65
doi: 10.1097/JNN.0000000000000174
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ABSTRACT: External ventricular drains (EVDs) are commonly used to facilitate removal of cerebrospinal fluid in patients with neurologic dysfunction. Despite a high risk for infection (upward of 45%), many hospitals lack strict protocols for EVD placement and maintenance. In addition, EVD infections are typically not tracked with the same diligence as central-line catheter infections, because there are no widely accepted standards for routine management of EVDs. The purpose of this review is to provide a guide for the development of a standardized, best practice EVD protocol for catheter insertion, care, and maintenance to reduce ventriculostomy-related infections. A secondary goal of this review is to provide support for the future development of guidelines for the consistent tracking of EVD insertion and maintenance practices.

At an academic medical center, an interdisciplinary team of nurses, advanced practice nurses, and neurointensivists reviewed recent medical and nursing literature as well as research-based institutional protocols on EVD insertion and maintenance from the United States and abroad to determine global best practices. The goal of this literature review was to identify key areas of focus in EVD insertion and maintenance as well as to identify recent studies that have shown success in managing EVDs with low rates of infection. The following terms were used in this search: EVD, externalized ventricular drains, EVD infections, EVD insertion, EVD Care and Maintenance, Nursing and EVDS. The following databases were utilized by each member of the interdisciplinary team to establish a state of the science on EVD management: American Association of Neurosurgical Surgeons, CINAHL, Cochrane, National Guidelines Clearinghouse, and PubMed. The following common EVD themes were identified: preinsertion hair removal and skin preparation, aseptic technique, catheter selection, monitoring of EVD insertion technique using a “bundle” approach, postinsertion dressing type and frequency of dressing changes, techniques for maintenance and cerebrospinal fluid sampling, duration of catheter placement, staff education/competence, and surveillance.

Questions or comments about this article may be directed to Millie Hepburn-Smith, RN MSN MPhil SCRN ACNS-BC, at millie.hepburn@gmail.com. She is a Neuroscience, Rehabilitation and Inpatient Psychiatry Nurse Educator, NYU Langone Medical Center, New York, NY.

Irina Dynkevich, RN MSN CNRN, is a Staff RN, Department of Neurosciences, NYU Langone Medical Center, New York, NY.

Marina Spektor, RN CNRN CSRN, is a Staff RN, Department of Neurosciences, NYU Langone Medical Center, New York, NY.

Aaron Lord, MD, is Assistant Professor, Division of Neurocritical Care, Department of Neurology, NYU Langone Medical Center, New York, NY.

Barry Czeisler, MD MS, is Assistant Professor, Division of Neurocritical Care, Department of Neurology, NYU Langone Medical Center, New York, NY.

Ariane Lewis, MD, is Assistant Professor, Division of Neurocritical Care, Department of Neurology, NYU Langone Medical Center, New York, NY.

The authors declare no conflicts of interest.

© 2016 American Association of Neuroscience Nurses