Drain Placement Research Articles

Are variations in ventricular catheter placement related to design of the catheter? A single-center cohort study

Background: The use of intracranial catheters is a common procedure used for neurosurgical patients with a variety of pathologies. Despite its frequency of use, shunt failure and revision have been reported to be a common problem. Given that depth of insertion can significantly affect the catheter tip position, a single institution retrospective chart review was performed to examine the accuracy of shunt and external ventricular drain (EVD) placement. Methods: Computed tomography (CT) images of the head following shunt or ventriculostomy insertion were analyzed to determine the delta between the final length of the intracranial catheter and the intended depth described in the operative notes. Results: We found that there was a statistically significant difference in the accuracy of placement when comparing EVDs to shunts. The most used EVDs at our institution are marked with a solid black line in increments spaced 2 cm apart. The most used ventricular shunt catheter has a marking at 5 cm and 10 cm from the tip of the catheter. We believe that the visual confirmation that is afforded by metric unit markings on the EVD allows for better final placement of the catheter at the outer table of the calvarium. Conclusion: The addition of regular millimeter metric unit markings by the manufacturer is imperative in decreasing the chances of error in the insertion of ventricular catheters and preventing potential neurovascular injury to the surrounding structures.

Chronic subdural hematoma: Management, sequelae with its predictive factors, and health-related quality of life of survivors

Objectives: The objective of the study is to identify the risk factors associated with chronic subdural hematoma (CSDH) in the Pakistani population, to compare various surgical techniques commonly used in its management, and to analyze the outcomes of patients, including early, that is, at the time of discharge, and late, that is, the disability status of patients on follow-up after ≥6 weeks. Materials and Methods: This retrospective study was carried out at a tertiary care hospital in Pakistan between March 2023 and October 2023 and included 100 patients with CSDH. All patients underwent surgical procedures, and outcomes were assessed at six weeks. Results: The mean age of the patients diagnosed with CSDH in this study was 53.81 ± 11.54 years. The most commonly reported symptom was an altered level of consciousness (30%), but most patients presented with more than one symptom (50%). Mortality was associated with only 10% of cases, and 90% reported no complications or significant morbidity. The most commonly used surgical technique was two burr-hole drainage (67%). The risk of recurrence was increased with the presence of comorbidities (P = 0.001) and remarkably reduced with intraoperative subdural drain placement (P = 0.000). Conclusion: The choice of surgical technique had no influence on the length of stay in the hospital or functional status post-discharge but surgery with intraoperative subdural drain placement proved to yield definitive favorable outcomes.

The Use of Subcutaneous Hemovac Drain after Open Heart Surgery with Sternotomy

Background: This study investigated the effect of subcutaneous Hemovac drain use on sternal wound complications in patients with a body mass index (BMI) ≥30 kg/m2 undergoing open heart surgery through median sternotomy. Methods: This retrospective study included a total of 120 patients (74 males, 46 females) with a BMI ≥30 kg/m2 who underwent open heart surgery through median sternotomy between January 2021 and January 2024. The mean age was 60.36 ± 11.31 years (range, 18–80 y). After median sternotomy, a Hemovac drain was placed subcutaneously in the study group (n = 60) and in controls no Hemovac drain was placed (n = 60). Durations of hospital stay, types of surgery, sternal wound complications, and preoperative, intraoperative, and postoperative data were compared between the two groups. Results: The duration of hospital stay (p = 0.018; p < 0.05), the rate of sternal wound complications (p = 0.001; p < 0.01), the rate of superficial sternal complications (p = 0.001; p < 0.01), and the need for antibiotics in superficial infections (p = 0.001; p < 0.01) were significantly lower in cases with a Hemovac drain compared to those without. Conclusion: Subcutaneous placement of a Hemovac drain after open heart surgery is a simple, easily applicable, and effective method that reduces sternal wound complications, and hospital stay in obese patients.

Early Hospital Discharge on Day Two Post-Robotic Lobectomy with Telehealth Home Monitoring.

Background: Despite the implementation of enhanced recovery programs, the reported average postoperative length of stay after robotic lobectomy remains as 4 days. In this prospective study, we present the outcomes of early discharge (on day 2) with telehealth home monitoring device after robotic lobectomy for lung cancer in selected patients. Methods: All patients with a caregiver were discharged on postoperative day 2 (POD 2) with a telemonitoring device provided they met the specific discharge criteria. Inclusion criteria: <75 years old, stage I-II NSCLC, with caregiver, ECOG 0-2, scheduled for lobectomy, logistic proximity to hospital (<60 km); intra-postoperative exclusion criteria: conversion to open surgery, early complications needing hospital monitoring or redo-operation, difficult pain management, <92 HbO2% saturation on room air or need for O2 supplementation, altered vital or laboratory parameters. Teleconsultations were scheduled as follows: the first one in afternoon of POD2, two on POD3, then once a day until chest tube removal. After discharge, patients recorded their vital signs at least four times a day using the device, which allowed two surgeons to monitor them via a mobile application. In the event of sudden changes in vital signs or the occurrence of adverse events, patients had access to a direct phone line and a dedicated re-hospitalization pathway. The primary outcome was safety, assessed by the occurrence of post-discharge complications or readmissions, as well as feasibility. Secondary outcomes: comparison of safety profile with a matched control group in which the standard of care and the evaluation of resource optimization were maintained and economic evaluation. Results: Between July 2022 and February 2024, 48 patients were enrolled in the present study. Six patients (12.5%) dropped out due to unsatisfied discharge criteria on POD2. Exclusion causes were: significant air leaks (n:2) requiring monitoring and the use of suction device, uncontrolled pain (n:2), atrial fibrillation, and occurrence of cerebral ischemia (n:1 each). The adherence rate to vital signs monitoring by patients was 100%. A mean number of four measurements per day was performed by each patient. During telehealth home monitoring, a total of 71/2163 (1.4%) vital sign measurements violated the established acceptable threshold in 22 (52%) patients. All critical violations were managed at home. During the surveillance period (defined as the time from POD 2 to the day of chest tube removal), a persistent air leak was recorded in one patient requiring readmission to the hospital (on POD 13) and re-intervention with placement of a second thoracic drainage due to unsatisfactory lung expansion. No other postoperative complication occurred nor was there any readmission needed. Compared to the control group, the discharge gain was 2.5 days, with an economic benefit of 528 €/day (55.440 € on the total enrolled population). Conclusions: Our results confirm that the adoption of telehealth home monitoring is feasible and allows a safe discharge on postoperative day two after robotic surgery for stage I-II NSCLC in selected patients. A potential economic benefit (141 days of hospitalizations avoided) for the healthcare system could result from the adoption of this protocol.

Neurosurgical Procedures in Patients Requiring Extracorporeal Membrane Oxygenation.

Extracorporeal membrane oxygenation (ECMO) is often withheld in patients with significant neurologic injury or recent neurosurgical intervention due to perceived futility. Studies of neurosurgical interventions before or during ECMO are limited to case reports or single-center series, limiting generalizability, and outcomes in this population are unknown. We therefore sought to report the outcomes of ECMO patients with acute neurosurgical interventions at four high-volume ECMO and comprehensive stroke centers. Retrospective case series. Four academic tertiary referral hospitals in the United States. Adults (n = 24) having undergone neurosurgical procedures before or during ECMO. None. We retrospectively reviewed adults at four institutions who had undergone neurosurgical procedures immediately before or during ECMO from 2015 to 2023. The primary outcome was survival to hospital discharge. Secondary outcomes included favorable neurologic outcome (Cerebral Performance Category 1 or 2) and neurosurgical complications. Twenty-four of 2957 ECMO patients (0.8%) were included. Primary indications for neurosurgical intervention included traumatic brain (n = 8) or spinal (n = 3) injury, spontaneous intracranial hemorrhage (n = 6), and acute ischemic stroke (n = 5). Procedures included extraventricular drain (EVD) and/or intracranial pressure monitor placement (n = 10), craniectomy/craniotomy (n = 5), endovascular thrombectomy (n = 4), and spinal surgery (n = 3). Fifteen patients (63%) survived to hospital discharge, of whom 12 (80%) were discharged with favorable neurologic outcomes. Survival to discharge was similar for venoarterial and venovenous ECMO patients (8/12 vs. 7/12; p = 0.67) and those who had neurosurgery before vs. during ECMO (8/13 vs. 7/11; p = 0.92). One patient (4%) experienced a neurosurgical complication, a nonlethal tract hemorrhage from EVD placement. Survival to discharge was similar for neurosurgical and nonneurosurgical ECMO patients at participating institutions (63% vs. 57%; p = 0.58). Patients with acute neurologic injury can feasibly undergo neurosurgery during ECMO or can undergo ECMO after recent neurosurgery. Larger studies are needed to fully understand risks for bleeding and other procedure-related complications.

Intraoperative Factors Affecting Pain Management and Postoperative Narcotic Use in Cranial Vault Remodeling: A Retrospective Review

Perioperative pain control in open cranial vault reconstruction (CVR) poses significant challenges. Narcotic use may confound signs of neurological deterioration and cause medication-induced complications. Previous studies have shown improved health outcomes in CVR with reduced narcotic use. The purpose of this study was to investigate the relationship between modifiable intraoperative factors on postoperative narcotic use. A retrospective cohort study was performed on 237 patients with craniosynostosis who presented to a tertiary pediatric hospital over a 10-year period for open CVR. There was a statistically significant relationship between total fluid volume infused intraoperatively (mL/kg) and total morphine equivalents (MEs, mL/kg) given throughout hospitalization (P&lt; 0.001). Longer operative times were associated with greater total hospitalization ME (P ≤ 0.006) and total intraoperative blood products transfused (P ≤ 0.001). Patients who received drains were given significantly higher total hospitalization ME compared with those who did not (P&lt; 0.001). Patients who received postoperative nonsteroidal anti-inflammatory drugs required significantly fewer total ME compared with children who did not (P&lt; 0.005) and patients who received intraoperative tranexamic acid were less likely to require postoperative blood transfusion (P&lt; 0.001). Postoperative nonsteroidal anti-inflammatory drug use is associated with decreased narcotic requirements during the immediate postoperative period whereas increased fluid requirements intraoperatively, longer operative durations, and drain placement are associated with higher narcotic use. Modifying intraoperative factors like these may lead to decreased postoperative pain, thus limiting narcotic use for patients, and improving overall outcomes.

Bleeding complications related to external ventricular drainage placement in patients with ruptured intracranial aneurysms: a single-center study

ObjectiveAcute aneurysmal rupture can be treated with endovascular therapy or surgical clipping. For patients with concurrent acute hydrocephalus, the placement of an external ventricular drainage (EVD) is required. This study aims to investigate the impact of pre-treatment EVD placement on rebleeding in ruptured aneurysms and to examine the influence of dual antiplatelet therapy and the sequencing of dual antiplatelet therapy with EVD placement on EVD-related hematomas.MethodsWe reviewed the clinical data of 83 patients with ruptured aneurysms who underwent EVD placement from a total of 606 aneurysm patients consecutively admitted between January 2018 and January 2023. The analysis focused on the impact of pre-treatment EVD placement on aneurysmal rebleeding and the effect of dual antiplatelet therapy and its sequencing with EVD placement on EVD-related hematomas.ResultsAmong the 503 patients with ruptured aneurysms, 83 required EVD placement. EVD was placed before aneurysm treatment in 63 patients and after treatment in 20 patients. The number of aneurysmal rebleeding cases in the pre-treatment EVD group and non-EVD group was 1 (1.6%) and 20 (4.8%), respectively (p = 0.406). 31 patients (37.3%) underwent stent-assisted embolization or flow diversion requiring dual antiplatelet therapy, while 52 patients (62.7%) underwent simple embolization or surgical clipping without antiplatelet therapy. EVD-related hematomas occurred in 14 patients (16.9%), with 10 cases (32.3%) in those receiving dual antiplatelet therapy and 4 cases (7.7%) in those not receiving antiplatelet therapy (p = 0.01). Among 16 patients who had EVD placed before dual antiplatelet therapy, 4 (25%) developed EVD-related hematomas. Of the 15 patients who had EVD placed after dual antiplatelet therapy, 6 (40%) developed EVD-related hematomas (p = 0.458).ConclusionIn patients with aneurysmal subarachnoid hemorrhage (aSAH) and acute hydrocephalus, the placement of EVD before aneurysm treatment does not increase the risk of rebleeding. However, dual antiplatelet therapy increases the risk of EVD-related hematoma, and the sequence of EVD placement relative to dual antiplatelet therapy does not appear to significantly affect the outcome of EVD-related hematoma.

Comparative Assessment of Outcomes: Abdominal Drain vs. No Abdominal Drain after Left Pancreatectomy-A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed to compare outcomes between abdominal drain placement and no drain placement post-pancreatectomy. Left pancreatectomy (LP) is a surgical procedure commonly employed for various pancreatic conditions, often associated with postoperative complications like post-operative pancreatic fistula (POPF). While routine abdominal drainage following LP has been standard practice, recent evidence suggests potential benefits of omitting this approach. A comprehensive search was conducted on PubMed, Cochrane, and Embase from inception up to 15 March 2024, yielding nine studies comprising 15,817 patients. Data were extracted from randomized and non-randomized studies reporting primary and secondary outcomes. The analysis was performed in Revman. Risk ratios were calculated with 95% confidence intervals, and a P-value of <0.05 was considered statistically significant. A total of 13,081 patients underwent drain placement after left pancreatectomy, and 2,736 patients were included in the no-drain group. Out of the total, 45.1% (n=7140) patients were male, with 45.9% (n=6012) males in the drain group and 41.2% (n=1128) males in the no-drain group. Major morbidity, defined as Clavien-Dindo grade ≥III complications, was significantly lower in the no-drain group (relative risk [RR]: 0.77, 95% confidence interval [CI]: 0.64-0.93, P=0.006). Similarly, lower rates of postoperative pancreatic fistula (POPF) (RR: 0.51, 95% CI: 0.38-0.67, P<0.00001), readmission (RR: 0.75, 95% CI: 0.59-0.96, P=0.02), and surgical site infections (RR: 0.82, 95% CI: 0.70-0.95, P=0.009) were observed in the no-drain group. Additionally, a shorter length of hospital stay was noted in this group (mean difference MD: -1.65, 95% CI: -2.50 to -0.81, P=0.0001). Omitting routine drainage after left pancreatectomy is associated with reduced complications and shorter hospital stays, supporting its potential benefits in improving postoperative outcomes.

Loop-tip technique for replacing dislodged catheters

Accidental catheter dislodgement is a common occurrence following placement of drainage and vascular catheters. Several methods have been developed to replace dislodged catheters using existing catheter tracts. We describe a new technique using an adjustable self-centering “Loop-Tip” catheter to facilitate salvage of catheter tracts. The technique may be suitable for re-canalization of a wide variety of catheter tracts and sinus tracts.

Conservative Decompression in the Management of Odontogenic Keratocysts: Case Report

Aims: This study aims to assess the effectiveness of decompression as a conservative treatment for odontogenic keratocysts (OKCs), with emphasis on reducing recurrence rates, decreasing lesion size, and preserving adjacent anatomical structures. Additionally, it explores the combination of decompression with enucleation and other therapies to minimize recurrence risks. Presentation of Case: This is a case study focusing on conservative management of OKCs using decompression, with enucleation performed when necessary. A 15-year-old male patient with a mandibular OKC underwent decompression under local anesthesia. Preoperative radiographic evaluations were followed by aspirate puncture and placement of a thoracic drain to facilitate lesion size reduction. The patient was monitored over six months, with radiographic exams every 60 days to assess cyst shrinkage. Discussion: The patient showed a significant reduction in lesion size following decompression, allowing for easier enucleation while preserving the bone cortex. A review of the literature supports decompression as an effective treatment; however, recurrence rates remain problematic when performed without adjunctive therapies. Combining decompression with enucleation resulted in lower recurrence rates and improved long-term outcomes. Conclusion: Decompression is a promising conservative approach for managing OKCs, particularly when combined with enucleation and adjunctive treatments. This approach reduces lesion size and preserves critical structures, although recurrence remains a concern. Long-term follow-up and further research on recurrence mechanisms are essential to improving outcomes for patients treated with decompression for OKS.

Clinical outcomes of children with COVID-19 and appendicitis: a propensity score matched analysis.

Early in the COVID-19 pandemic, many children with appendicitis and COVID-19 were initially treated non-operatively and later underwent interval appendectomy. Currently, children with both appendicitis and COVID-19 frequently undergo upfront appendectomy. The impact of this return to upfront surgical management on patient outcomes is unknown. This study compared outcomes of pediatric patients with and without COVID-19 infection undergoing appendectomy. A retrospective cohort study of children < 21y who underwent appendectomy from 3/19/2020 to 7/31/2022 at 50 Pediatric Health Information System children's hospitals was conducted. Children with documented COVID-19 were identified. Exclusions included preoperative ventilator or supplemental oxygen dependence, and missing data. To evaluate COVID-19 positive versus COVID-19 negative patients, we used a propensity score matched on sociodemographics, comorbidities, laparoscopy, perforation, and hospital. Chi-square and Mann-Whitney U tests identified differences between groups in length of stay, postoperative drain placement, 30-day re-admission, and mechanical ventilation requirements. Overall, 51,861 children of median age 11y (IQR: 8-14) underwent appendectomy, of whom 1,440 (2.3%) had COVID-19. Most were male (60.3%), White (72.1%) and non-Hispanic (61.4%). Public insurance was the most common (47.5%). We created a matched cohort of 1,360 COVID-19 positive and 1,360 COVID-19 negative children. Children with COVID-19 had shorter hospitalizations (1d, IQR: 1-4 vs. 2d, IQR: 1-5, p = 0.03), less postoperative peritoneal drain placement (2.4% vs. 4.1%, p = 0.01), and fewer 30-day readmissions (9.0% vs. 11.4%, p = 0.04). However, no difference in incidence or duration of mechanical ventilation (p > 0.05) was detected. Our findings suggest that upfront appendectomy for children with appendicitis and COVID-19 has similar outcomes compared to children without COVID-19. Level III.

Bailout for the Difficult Gallbladder: Subtotal vs. Open Cholecystectomy-A Retrospective Tertiary Care Center Experience.

Background and Objectives: A difficult gallbladder anatomy augments the risk of bile duct injuries (BDIs) and other complications during a laparoscopic cholecystectomy. This study compares the outcomes of a laparoscopic subtotal cholecystectomy (LSTC) and open total cholecystectomy (OTC) for difficult cholecystectomies. Materials and Methods: This retrospective analysis of gallbladder procedures (LSTC or OTC) from 2016 to 2023 examined patient demographics, surgical details, and postoperative results. The primary outcome was the incidence of a BDI. Secondary outcomes included operative duration, blood loss, and postoperative complications. Results: Seventy-one patients were included in the study. Of them, 59.2% (n = 42) underwent an LSTC and 44.6% (n = 29) underwent an OTC. The LSTC cohort was more likely to have a day-surgery case with a same-day discharge (33.3% vs. 0%, p = 0.009), less blood loss (71.4 ± 82.26 vs. 184.8 ± 234.86, p = 0.009), and a shorter operative duration (187.86 ± 68.74 vs. 258.62 ± 134.52 min, p = 0.008). Furthermore, BDI was significantly lower in the LSTC group (2.4% vs. 17.2%, p = 0.045). However, there were no significant differences between the two groups concerning intraoperative drain placement, peri-cholecystic fluid collection, bile leak, and other complications (p > 0.05). Conclusions: LSTC is a safe and effective alternative to OTC for challenging gallbladder cases. Further studies with larger sample sizes and longer follow-up periods as well as different study designs are warranted.

The utility of point-of-care ultrasound in critical care nephrology.

Point-of-care ultrasonography (POCUS) is gaining heightened significance in critical care settings as it allows for quick decision-making at the bedside. While computerized tomography is still considered the standard imaging modality for many diseases, the risks and delays associated with transferring a critically ill patient out of the intensive care unit (ICU) have prompted physicians to explore alternative tools. Ultrasound guidance has increased the safety of invasive procedures in the ICU, such as the placement of vascular catheters and drainage of collections. Ultrasonography is now seen as an extension of the clinical examination, providing quick answers for rapidly deteriorating patients in the ICU. The field of nephrology is increasingly acknowledging the value of diagnostic point-of-care ultrasound (POCUS). By employing multi-organ POCUS, nephrologists can address specific queries that arise during the diagnosis and treatment of patients with acute kidney injury. This approach aids in ruling out hydronephrosis and offers immediate information on hemodynamics, thereby consolidating patient data and facilitating the development of personalized treatment strategies.

An Improvised External Ventricular Drain Fixation Technique to Avoid Pullout-Related Complications in a Low-Resource Setting: A Descriptive Cross-Sectional Study in a Single Center of Nepal.

An external ventricular drain (EVD) placement is a commonly performed life-saving procedure. Its accidental pullout can occur in complex environments, patient care, and positioning, which leads to significant morbidity. The method of EVD fixation and pullout rates is sparsely described in the literature, and there exists a wide variation among the techniques practiced for fixation. However, some techniques require additional tools, which are expensive and unavailable in low-resource settings. We describe an improvised method of securely fixing the EVD to the scalp applicable in low-resources and describe the EVD pullout rate with the use of this technique. A retrospective review of pullout-related complications in 107 consecutive patients was performed. The EVD was fixed to the scalp using an improvised technique to loop the catheter around a soft flange and secure it with sutures. Pullout occurred in 1 patient (0.93%), who was in an alcohol withdrawal state and deliberately pulled out the catheter. There were zero nondeliberate pullouts. EVD fixation by coiling the catheter around a soft flange has a low pullout rate. Because it is secure and requires only a flange, it is suitable for low-resource settings.

Thyroid Uncomplicated Surgery with Lack Placement of Drains. A Retrospective Analysis.

Thyroid drains after thyroid surgery are often used despite evidence. The aim of this retrospective study was to determine the post-operative complication rates following thyroid uncomplicate surgery without drain. The medical records of two hundred and thirty-nine patients who undergone thyroid surgery without and with drain were reviewed. The rate of post-operative either complications and pain were evaluated. The distribution of the operations performed were similar in two groups, in no-drain group (group A) there were total thyroidectomy 68.7% and lobectomy 31.3% while in drain group (group B) the total thyroidectomy were 70.8% and the lobectomy were 29.2%, this without statistical significant difference. Postoperative complications that occurred included seromas, hematoma and wound infections were without significantly differences. Postoperative pain was significantly lower in group A than in group B at two timepoint. The mean hospital stay was significantly shorter in the non-drained group. The no-drain uncomplicated thyroid surgery was safe and didn't increase a rates of post-operative complications. In addition, we achieved significant reduction of postoperative pain, hospital stay and overall costs.

Early Fusariosis after Peritoneal Dialysis Drain Placement

Early Fusariosis after Peritoneal Dialysis Drain Placement

RETRACTION: Effect of drain placement in short-level spinal surgery on postoperative wound infection: A meta-analysis.

Retraction: B. Zhan, S. Fang, X. Lv, X. Xie, X. Wang, "Effect of Drain Placement in Short-Level Spinal Surgery on Postoperative Wound Infection: A Meta-Analysis," International Wound Journal 21, no. 3 (2024): e14508, https://doi.org/10.1111/iwj.14508. The above article, published online on 01 December 2023, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the journal Editor in Chief, Professor Keith Harding; and John Wiley & Sons, Ltd. It came to the publisher's attention from a third party that a number of articles shared concerning similarities in format and structure. Following an investigation by the publisher, the retraction has been agreed on as the peer review and publishing process for this article were found to be manipulated. The authors did not respond to the notice of retraction.

Safe external ventricular drain management for infection prevention and control: a narrative review

Introduction: External ventricular drain (EVD) placement is a common neurosurgical procedure. Nurses play a crucial role in care, troubleshooting, and monitoring of EVD-related complications, making their education and training in this area of paramount importance. A well-trained nurse possesses the necessary knowledge and skills to recognize and respond promptly to EVD-related complications, such as infections, bleeding, and blockages. External ventricular drainage is associated with a high rate of nosocomial meningitis. The introduction of a well- implemented EVD care bundle can significantly decrease EVD infection rates. The support of the multi-item bundle for EVD is considered very important to reduce EVD-related infections.Aim: To summarize the most recent available evidence for the prevention and control of EVD infections. Methods: Comprehensive literature search had been done using the PubMed (Medline), Embase, CINAHL, and Cochrane databases. The narrative review was performed according to the PRISMA Extension for Scoping Review checklist (PRISMA-ScR).Results: The query identified 4266 studies; after duplicate removal and exclusion of papers due to non-pertinent criteria, 26 studies were included. Only three papers were related to pediatric patients and all were about EVD anchoring. Regarding the risk of infection, bundles and protocols are important for the reduction of the occurrence rate; however, staff adherence to these is fundamental.Conclusion: Multidisciplinary staff and training are fundamental to improve EVD management. Avoiding routine or daily sampling reduces the EVD infection rate. When the procedure is requested, it is important to follow a strict protocol and to use sterile techniques. Hydrocolloid dressings, SecurAcath, gauze, and film dressings were used to anchor the cover EVD in the studies.

Comparing fourth-year medical students’ procedural surgical skill learning outcomes between third-person point-of-view video lectures and first-person point-of-view immersive virtual reality: a pilot study of surgically implanting a subdermal drain on cadavers

The use of virtual reality (VR) training in medical school education has increased over the last decade partly due to coronavirus-19 (COVID-19) and due to technology advancements in this integrative area. As medical students are being trained in new pedagogical interventions, it is important to drill-down and focus on the areas of most translational concern for assessing their competency and proficiency. Thus, the present pilot study sought to evaluate a group of fourth-year medical students’ ability to learn a modified medical school curriculum on implementing a subdermal drain by first learning how to stitch on a silicone model (i.e., proper stitching only) and then being randomly assigned to either a third-person point-of-view (TP-POV) or first-person point-of-view (FP-POV) immersive VR group to learn how to conduct the surgical procedure (i.e., conceptually and procedurally). Then, the participants’ surgical procedural motor skills were assessed on a single attempt to demonstrate their competency and proficiency on a cadaver. The results showed that the pedagogical learning differences in FP-POV immersive VR improved the cleanliness and accuracy of the surgical dissection movement and drain placement with 100% proficiency in the first attempt at implementing this surgical technique on a cadaver. Additionally, there was statistically significant improvement in the dissection movement (p &amp;lt; 0.05*) and the tension test (p &amp;lt; 0.01**) in the FP-POV group compared to the TP-POV group, even with a small sample size in the present pilot study. These findings offer unique training opportunities to be considered when designing future VR curriculum with the suggested use of repeated-measures designs on the surgical procedural motor skills to assess learning curves and their potential translations in reducing operating room errors, costs, planning and scheduling times, and surgery overlaps, thereby positively contributing to a more efficient and safer OR surgical experience by staff and patients in the near future.

Efficacy of subperiosteal drains in chronic subdural hematoma: a prospective randomized single-center study.

Background Chronic subdural hematomas (cSDH) are most frequently treated by evacuation via a burr-hole craniostomy procedure. Subperiosteal drains have been introduced as alternatives to subdural ones but only a few prospective studies have explored their efficacy. Thus, a prospective randomized trial was designed to assess their use. Methods The study enrolled patients with newly diagnosed surgically amenable cSDH. These patients were randomized into two groups. The first group underwent cSDH evacuation via a single burr-hole craniostomy procedure followed by placement of a subperiosteal drain; the second group underwent the identical procedure without drain placement. Patient demographics, drain volumes, duration of drainage, cSDH recurrence, and postoperative outcomes were recorded. Results Eighty-eight patients presenting with cSDH (12 with bilateral findings) from a total of 100 surgical cases were enrolled. Nine patients (1 bilateral) were lost to follow-up. Of all remaining 90 procedures, 37 were carried out with drain placement and the remaining 53 without. There were 5 recurrent cases (13,5%) in the drain group and 17 (32,1%) in the control group without drain placement. This resulted in a statistical significance (OR 0.33; p&lt;0.05) favoring the use of a drain. Conclusion Subperiosteal drain placement can be used safely and effectively to treat cSDH in conjunction with a burr-hole craniostomy procedure, significantly reducing the rate of recurrence without any additional disadvantages.