A Scoping Review of the Use of Improvised External Ventricular Drains in Africa

Abstract

Poor access to neurosurgical equipment is one of the problems limiting service delivery in Africa. Improvised surgical devices have long been used in Africa as replacements for high-cost standard versions. In this study, we aimed to see if improvised external ventricular drains (EVD) are being used, how these devices are made, and what their outcomes are. The PRISMA extension for scoping reviews was used in conducting this study. A search was conducted from inception to July 2022. PubMed, Ovid Embase, and African Journal Online were searched. Three studies were identified and used. The methods of making the EVD devices were compared and the incidence proportions of improvised EVD-related infections were calculated. The standard ventricular catheter was replaced by cheaper alternatives like a size 6/8 feeding tube or a 14-gauge central line catheter. The connecting tube had low-cost alternatives, and in a study, was replaced by a fluid infusion set. Aggregated outcomes from the three identified studies show that just over half of the sample survived post-EVD insertion (54%). The incidence proportion of EVD-related infections was 24%. This study describes the experience of African centers with an improvised version of the EVD devices and their outcomes. This will serve as a baseline for more research into the use of improvised EVD devices in low-resource settings.

External ventricular drain migration into the cisterna magna: A case report

“…The first is the use of a commercial EVD system if it is available. There have been published reports on the use of improvised EVD systems in low-resource settings for economic reasons,[ 6 ] but commercial EVD systems have been found to be superior in terms of lower infection and malfunction rates compared to improvised ones. [ 7 , 9 ] The increase in EVD-related infections is attributed to the lack of antibiotic impregnation in improvised EVDs.…”