Abstract
Background:Insertion of an External Ventricular Drain (EVD) is arguably one of the most common and important lifesaving procedures in neurologic intensive care unit. Various forms of acute brain injury benefit from the continuous intracranial pressure (ICP) monitoring and cerebrospinal fluid (CSF) diversion provided by an EVD. After insertion, EVD monitoring, maintenance and troubleshooting essentially become a nursing responsibility.Methods:Articles pertaining to EVD placement, management, and complications were identified from PubMed electronic database.Results:Typically placed at the bedside by a neurosurgeon or neurointensivist using surface landmarks under emergent conditions, this procedure has the ability to drain blood and CSF to mitigate intracranial hypertension, continuously monitor intracranial pressure, and instill medications. Nursing should ensure proper zeroing, placement, sterility, and integrity of the EVD collecting system. ICP waveform analysis and close monitoring of CSF drainage are extremely important and can affect clinical outcomes of patients. In some institutions, nursing may also be responsible for CSF sampling and catheter irrigation.Conclusion:Maintenance, troubleshooting, and monitoring for EVD associated complications has essentially become a nursing responsibility. Accurate and accountable nursing care may have the ability to portend better outcomes in patients requiring CSF drainage.
Highlights
Insertion of an external ventricular drain (EVD) is arguably one of the most common and most important lifesaving procedures encountered in the neurologic intensive care unit.[5]
Various types of acquired brain injury, such as intracranial hemorrhage with intraventricular extension, subarachnoid hemorrhage, traumatic brain injury, and bacterial meningitis, may benefit from External Ventricular Drain (EVD) insertion. Many of these conditions are associated with intracranial hypertension or raised intracranial pressure (ICP) above 20 mmHg due to obstruction of cerebrospinal fluid (CSF) outflow.[5]
CSF is circulated along the ventricular system into the subarachnoid space and absorbed into the venous system within the arachnoid granulations that line the convexity of the brain
Summary
Insertion of an External Ventricular Drain (EVD) is arguably one of the most common and important lifesaving procedures in neurologic intensive care unit.
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