Protocols for External Ventricular Drains

Three distinct purposes exist for the placement of an external ventricular drain like Traumatic brain injury, hydrocephalus and Intra ventricular hemorrhage.

  • Commonest site chosen for Burr hole is right frontal region.
  • All patients EVD is done at the Operating room only.
  • The drainage level will be set and adjust by the Neurosurgeons.
  • Proper antibiotics administered.
  • Changes in the threshold for drainage are made after consultation with the neurosurgeons.
  • Minimum time limit for an EVD is 3-5 days.
  • More prolonged drainage would be implemented by the Neurosurgeons.
  • Routine CSF sampling for infection surveillance is not performed.
  • CSF specimens are to be sent as part a fever workup or 2-3 days prior to planned-shunt placement.
  • CSF samples sent to evaluate for infection include the following: glucose, protein, lactate, cell count, grams state and culture.
  • In patient for whom there is concern for possible CSF infection a CSF sample should be obtained prior to removal of the ventricular catheter.

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