A nationwide prospective multicenter study of external ventricular drainage: accuracy, safety, and related complications

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  • 1 Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada;
  • | 2 Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada;
  • | 3 Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada;
  • | 4 Université de Laval, CHU de Québec Hôpital-Enfant-Jésus, Laval, Québec, Canada;
  • | 5 Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada;
  • | 6 Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada;
  • | 7 Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada; and
  • | 8 Division of Neurosurgery, Université de Sherbrooke, Sherbrooke, Québec, Canada
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OBJECTIVE

External ventricular drainage (EVD) catheters are associated with complications such as EVD catheter infection (ECI), intracranial hemorrhage (ICH), and suboptimal placement. The aim of this study was to investigate the rates of EVD catheter complications and their associated risk factor profiles in order to optimize the safety and accuracy of catheter insertion.

METHODS

A total of 348 patients with urgently placed EVD catheters were included as a part of a prospective multicenter observational cohort. Strict definitions were applied for each complication category.

RESULTS

The rates of misplacement, ECI/ventriculitis, and ICH were 38.6%, 12.2%, and 9.2%, respectively. Catheter misplacement was associated with midline shift (p = 0.002), operator experience (p = 0.031), and intracranial length (p < 0.001). Although mostly asymptomatic, ICH occurred more often in patients receiving prophylactic low-molecular-weight heparin (LMWH) (p = 0.002) and those who required catheter replacement (p = 0.026). Infectious complications (ECI/ventriculitis and suspected ECI) occurred more commonly in patients whose catheters were inserted at the bedside (p = 0.004) and those with smaller incisions (≤ 1 cm) (p < 0.001). ECI/ventriculitis was not associated with preinsertion antibiotic prophylaxis (p = 0.421), catheter replacement (p = 0.118), and catheter tunneling length (p = 0.782).

CONCLUSIONS

EVD-associated complications are common. These results suggest that the operating room setting can help reduce the risk of infection, but not the use of preoperative antibiotic prophylaxis. Although EVD-related ICH was associated with LMWH prophylaxis for deep vein thrombosis, there were no significant clinical manifestations in the majority of patients. Catheter misplacement was associated with operator level of training and midline shift. Information from this multicenter prospective cohort can be utilized to increase the safety profile of this common neurosurgical procedure.

ABBREVIATIONS

DVT = deep vein thrombosis; ECI = EVD catheter infection; ED = emergency department; EVD = external ventricular drainage; ICH = intracranial hemorrhage; ICU = intensive care unit; IVH = intraventricular hemorrhage; LMWH = low-molecular-weight heparin; OR = operating room; PGY = postgraduate year; SAH = subarachnoid hemorrhage.

Illustration from Morshed et al. (pp 1–8). Copyright Ken Probst. Published with permission.

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