Use of a cyanoacrylate skin adhesive to reduce external ventricular drain infection rates

Clinical article

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  • 1 Children's Healthcare of Atlanta, Georgia;
  • 2 Department of Neurosurgery, Temple University, Philadelphia, Pennsylvania; and
  • 3 Capital Institute for Neurosciences, Pennington, New Jersey
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Object

Ventriculitis related to external ventricular drain (EVD) placement is a significant source of morbidity in neurological intensive care patients. Current rates of EVD-related infections range from 2% to 45% in the literature. The authors sought to determine if a 2-octyl cyanoacrylate adhesive would result in lower infection rate than standard semiocclusive dressings.

Methods

The authors tracked ventriculitis rates via CSF cultures among 259 patients whose EVD sites were dressed with sterile semiocclusive dressings and underwent routine sterile dressing exchanges every 48 hours. They analyzed data obtained in an additional 113 patients whose EVD sites were dressed one time with a surgical adhesive, 2-octyl cyanoacrylate.

Results

Ventriculitis rate in patients with standard bioocclusive dressings and wound care was 15.1%, whereas that in patients with a 2-octyl cyanoacrylate dressing was 3.54% (p = 0.002). Staphylococcus genus accounted for 79.5% of instances of ventriculitis among patients with bioocclusive dressings and routine wound care, whereas it accounted for 25.0% of the instances of ventriculitis among patients with a liquid polymer sealant dressing. A 90% reduction in Staphylococcus infection completely accounts for the observed effect (p = 0.04).

Conclusions

The one-time application of 2-octyl cyanoacrylate to EVD wounds and exit sites provided superior protection against EVD-related ventriculitis compared to conventional EVD-site wound care. Likely this protection results from a barrier to the entry of gram-positive skin flora along the EVD exit tract. The results should be validated in a randomized trial.

Abbreviations used in this paper:AUC = area under the curve; CDC = Centers for Disease Control and Prevention; EVD = external ventricular drain; GCS = Glasgow Coma Scale; RBC = red blood cell; ROC = receiver operating characteristic; WBC = white blood cell.

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Contributor Notes

Address correspondence to: Patrick J. Connolly, M.D., Capital Institute for Neurosciences, Two Capital Way, Pennington, NJ 08534. email: patrconn@mac.com.

Please include this information when citing this paper: published online February 7, 2014; DOI: 10.3171/2013.12.JNS13700.

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