Effectiveness of a Standardized External Ventricular Drain Placement Protocol for Infection Control

Abstract

Placement of an external ventricular drain (EVD) is a common procedure routinely completed at bedside by neurosurgical residents. A standardized protocol for placement and maintenance of an EVD is potentially useful. This single-institution retrospective review analyzed all patients who underwent placement of an EVD over a 5-year span using a standardized protocol. A total of 428 EVDs in 381 patients were placed as per this protocol. Overall compliance with the practice protocol was 98.7%. Overall, our infection rate was 1.86% (8 external ventricular drain-related infection [ERIs] over 428 EVDs). There was no difference in age for the ERI cases (median 55, range (50.5-60.5), compared with the non-ERI cases (median of 53, range [38-65]) (P= 0.512). Indications for placement of EVD were hemorrhage (51.9%, n= 198), tumor (16.2%, n= 62), trauma (12.8%, n= 49), hydrocephalus (11.5%, n= 44), cerebellar stroke (2.8%, n= 11), infection (3.1%, n= 12), unknown (1.3%, n= 5). Most EVDs (77.6%, n= 296) were placed bedside by second-year residents (median PGY level 2, interquartile range 1-2.75). Computed tomography confirmed placement in the ipsilateral frontal horn in 72% (n= 277) of EVDs. EVD-related complications were noted in 8.3% of EVDs (n= 32, with 8 infections and 24 tract hemorrhages). The median EVD duration was 10 days; duration of EVD had no statistically significant impact on the risk of an ERI (P= 1). Only replacement of an EVD was associated with an increased risk of infection. Adherence to a standard EVD placement protocol is useful in maintaining a low risk of ERI regardless of the duration of catheter utilization. Replacement of the catheter through the same access hole as the original catheter is associated with an increased risk of ERI.