Venticulostomy
aka IVC EVD
1.2-1.6 are acceptable INRs to place Ventric (J Trauma 2011;70:1112)
SR shows perhaps we should be giving abx or using abx coated EVDs throughout time (Neurosurgery 68:996–1005, 2011)
Ultrasound-guided EVD placement (Neurocrit Care 2012;17:255)
Insertion
Kocher’s point-12-13 cm posterior to nasion (nasal bridge) 2-3 cm lateral to midline, preferably in the non-dominant side. Correlate with mid-pupillary line and anterior to the coronal suture.
Aim at tragus for A/P and medial canthus for laterality. Should be approx perpendicular to skull at kocher’s point
Usually feel a pop at 4-5 cm
then soft-advance to 6.5-7
Usually start drainage at 10-20 cm/H20
Can test drainage by occluding the Jugs, ICP should rise or lower the head of bed
normal csf drainage 250ml or if patient is obstructed, up to 450-700
No Draining CSF
lower below head level to see if you can get 2-3 drops of CSF (no more than this should be drained)
If no one way valve on drainage system, raise above patients head to see bouncing/tidaling=indicates good CSF movement but collapsed ventricles
Can flush DRAINAGE portion if visible clot or air. Make sure nurses record this as supplemental drainage.
Gently aspirate with syringe with preservative free NS
Gently flush 1-2 ml NS
Get head CT
Taking CSF samples
full sterile
waste 2 ml
take 2 ml
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raise EVD level 5 cm/day and monitor CSF until 20 cm
after 1 day at 20cm, clamp EVD and monitor ICP for 24 hrs
Obtain head CT
Repeat CT before D/c from hospital
Failure of trial-ICP > 25 for 5 minutes, ICP with neuro exam change, CSF from wound or another drain site
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