Applicability, Safety, and Cost-Effectiveness of Improvised External Ventricular Drainage: An Observational Study of Tunisian Neurosurgery Inpatients

Kammoun, B.; Kolsi, F.; Borni, Mehdi; Abdelhedi, Anis; Abdelmouleh, S.; Jarraya, Firas; Bouhamed, Oussama; Kammoun, Omar; Elleuch, E.; Boudawara, Mohamed Zaher

doi:10.1016/j.wneu.2018.07.261

Cited by 11 publications

(11 citation statements)

References 11 publications

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“…This formed the proximal part of the EVD device. The choice of the connecting tube that connects the graduated chamber to the primary EVD system varied between studies, with Kammoun et al using alternatives like a manually redesigned Foley catheter or Redon tubing [ 14 ]. Setting the pressure involved a manual reference measurement done from the external auditory meatus (EAM).…”

Section: Reviewmentioning

confidence: 99%

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

Jesuyajolu¹,

Aremu²,

Olukoya³

et al. 2022

Cureus

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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.

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Section: Reviewmentioning

confidence: 99%

“…Setting the pressure involved a manual reference measurement done from the external auditory meatus (EAM). In one of the model designs reported by Kammoun et al, a repurposed blood transfusion drip chamber was placed against a transparent ruler mimicking the standard pressure measurement in a traditional EVD device [ 14 ].…”

Section: Reviewmentioning

confidence: 99%

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

Jesuyajolu¹,

Aremu²,

Olukoya³

et al. 2022

Cureus

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“…In resource-limited settings, commercially manufactured EVD sets are not always accessible and affordable. Improvisations using readily available apparatuses to monitor ICP and temporarily drain CSF have been reported in the literature with success and minimal complications [148,149,150]. At hospitals in Nigeria and India, feeding tubes have been reported as substitutes to EVD catheters whilst a sterile urine collection bag completes the closed drainage system [148,150].…”

Section: Literature Reviewmentioning

confidence: 99%

“…At hospitals in Nigeria and India, feeding tubes have been reported as substitutes to EVD catheters whilst a sterile urine collection bag completes the closed drainage system [148,150]. In an observational study in a Tunisian hospital, a 14-gauge central catheter assembled on a metal guide acted as a catheter, with the suture wings aiding fixation post-tunnelling [149]. Whilst post-operative complications mentioned in Section 3.5 can still occur, these makeshift EVDs may be useful [149].…”

Section: Literature Reviewmentioning

confidence: 99%

“…In an observational study in a Tunisian hospital, a 14-gauge central catheter assembled on a metal guide acted as a catheter, with the suture wings aiding fixation post-tunnelling [149]. Whilst post-operative complications mentioned in Section 3.5 can still occur, these makeshift EVDs may be useful [149]. Nevertheless, this highlights the issue that affordable equipment should be a priority target for universal health coverage; for example, in the field of hydrocephalus, affordable shunts have been manufactured and have been found to be effective [151].…”

Section: Literature Reviewmentioning

confidence: 99%

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The Evolution of the Role of External Ventricular Drainage in Traumatic Brain Injury

Chau

Craven

Rubiano

et al. 2019

JCM

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External ventricular drains (EVDs) are commonly used in neurosurgery in different conditions but frequently in the management of traumatic brain injury (TBI) to monitor and/or control intracranial pressure (ICP) by diverting cerebrospinal fluid (CSF). Their clinical effectiveness, when used as a therapeutic ICP-lowering procedure in contemporary practice, remains unclear. No consensus has been reached regarding the drainage strategy and optimal timing of insertion. We review the literature on EVDs in the setting of TBI, discussing its clinical indications, surgical technique, complications, clinical outcomes, and economic considerations.

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