Care of patient with external ventricular drain

Care of patient with external ventricular drain, EVD

1. Care of the patient with EVD Evaluator: Mr L Anand Presenter: Shruti Shirke CON AIIMS BBSR

2. Introduction External ventricular drains are life-saving devices used in neurosurgical patients with hydrocephalus (excessive amounts of cerebrospinal fluid). The fluid is produced in the brain ventricles and circulates around the brain and spinal cord, protecting them from injury and supplying brain cells with nutrients.

3. Introduction cont.. Hydrocephalus is a surgical emergency and its treatment involves inserting an external ventricular drain (EVD) into one of the lateral ventricles of the brain to remove excess cerebrospinal fluid (CSF ).

4. Introduction cont.. Nurses are responsible for the care of patients who have external ventricular drains.

5. Hydrocephalus cont.. Raised ICP is critical because: It reduces blood flow to the brain, starving it of oxygen, glucose and other vital substances. Eventually lead to brain herniation, an emergency in which the brain shifts into any available space – usually downwards. Crushing the structures of the brain stem and impeding the vital functions they control, such as respiration and heart rate .

6. Definition of terms External ventricular drain (EVD) : A temporary system that allows drainage of cerebral spinal fluid (CSF) from the ventricles to an external closed system. Intracranial pressure (ICP) monitoring : A temporary device allowing measurement and recording of intracranial pressure

7. Definition of terms cont … Cerebral Perfusion Pressure (CPP) : Pressure of blood perfusing the brain. CPP= Mean Arterial Pressure (MAP) – ICP. Normal CPP is 60 and 80 mm Hg Lumbar drainage devices : A temporary device allowing drainage of cerebral spinal fluid (CSF) from the subarachnoid space to an external closed system.

8. Definition of terms cont … Hydrocephalus : An abnormal accumulation of cerebral spinal fluid in the ventricles within the brain. Meningitis : An inflammation of the protective membranes that surround the brain. Intracranial Pressure (ICP) : Pressure within the skull. Contributed to by volume of brain tissue, CSF and blood.

9. Indicators for external ventricular drain insertion

10. Procedure

11. Monitoring CSF drainage Outside the skull, the catheter is connected to a drainage system consisting of a collection chamber collection chamber and drainage bag allow control of the entry of CSF and its drainage. The collection chamber and pressure scale hang side by side. Pressure is measured in millimetres of water pressure (cmH20 ). The scale includes both positive and negative measurements; zero corresponds to the pressure where the catheter enters the ventricle, and should always be horizontally level with the tragus of the patient’s ear. When the patient is lying on one side, this anatomical reference point becomes the bridge of the nose.

12. Monitoring CSF drainage cont.. It is a key nursing responsibility to ensure that zero on the pressure scale is level with the patient’s tragus at all times. If the collection chamber hangs from a higher point, it will drain CSF from a higher pressure in the ventricles than one hanging from a lower point . the collection chamber must be checked frequently to ensure it is neither too high (which would cause under-drainage of CSF) nor too low (which would cause over-drainage ).

13. Problems associated with EVDs

14. Infection

15. Over- and under-drainage

16. Trauma and haemorrhage

17. Blockage

18. Monitoring and documentation

19. Competencies for managing patients with external ventricular drains Know infection control policies about handling, monitoring and cleaning medical devices Know how to assess patients for infection Be able to apply principles of asepsis Understand how external ventricular drains (EVDs) work and appreciate importance of maintaining alignment with tragus Know the ‘on’ and ‘off’ positions of stopcock Be able to identify indications for and complications of EVDs Know how to manage complications Be able to use the Glasgow Coma Scale to detect early neurological deterioration