P51 External Ventricular Drainage Insertion Audit

Abstract

IntroductionExternal Ventricular Drainage (EVD) is a neurosurgical technique used to lower the intercranial pressure while cerebrospinal fluid (CSF) flow is obstructed. The infection rate associated with the EVD insertion in the UK is 9.3%, with ventriculitis being the most common one. The aim of the audit was to compare our outcomes and infection rates and national standards and to implement an EVD Management protocol to improve patient outcome.MethodsThe data was collected from 43 patients, 98% of whom were emergency admitted cases. For all EVD procedures, silver coated catheters were used. The surgical factors such as the surgical team performance and the average operative time (1h 11min) were accounted for in the audit. The most common reason for EVD insertion was subarachnoid haemorrhage. Prophylactic antibiotics were administered in all cases before the surgery. 12% of the EVDs were used for Intercranial Pressure Monitoring.Results12% patients’ samples had catheter associated infections. The average EVD insertion period was 18 days. Leaks occurred in 11 cases (26%). 3 of them subsequently developed ventriculitis. White cell count result was over 10,000 cells per mm3 in 40% of patients.ConclusionsTwice longer sampling time then the national average (8 days) increased the number of ITU transfers. The cause would be the use of out-of-date EVD type. However, the silver impregnated lines versus non-impregnated have a lower cerebrospinal fluid infection rate, the bolt connected EVDs would be more precise and decrease the rate of resuturing and hence decrease a chance of CSF infection.