External ventricular drain infection: improved technique can reduce infection rates

Kitchen, William John; Singh, Navneet; Hulme, Sharon; Galea, James; Patel, Hiren C.; King, Andrew T.

doi:10.3109/02688697.2011.578770

Cited by 63 publications

(42 citation statements)

References 24 publications

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“…(Hoefnagel et al, 2008;Kitchen et al, 2011;Korinek et al, 2005;Lwin, Low, Choy, Yeo & Chou, 2012;Muttaiyah et al, 2008;Pfisterer, Muhlbauer & Reinprechtet, 2003;Williams et al, 2011;Williamson et al, 2014).…”

Section: Resultsunclassified

“…The technique must be done aseptically and only by trained medical or nursing staff (Kitchen et al, 2011). Every sample taken and each manipulation of the system is associated with increased risk of introducing infection into the closed system (Williamson et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…From further review of the article it was evident to Williamson et al, (2014) that there was an associated link between CSF sampling and EVD-related bacterial ventriculitis and that specimens should only be taken at the medical team's discretion when clinical evidence of sepsis is noted. Kitchen et al, (2011) also conducted a study that initiated the sampling of CSF from a patient's EVD at the medical team's discretion. It was a prospective study that determined that frequency in sampling did not increase the risk of EVD associated infections as long as the clinicians had adequate experience and used theatre-standard aseptic technique.…”

Section: Discussionmentioning

confidence: 99%

“…The insertion of a ventricular catheter interrupts what is normally a closed ventricular system inside the cranium, which in turn places the patient at significant risk of complications. One of the most common complications is ventriculitis (Kitchen, Singh, Hulme, Galea, Patel & King, 2011).…”

Section: Introductionmentioning

confidence: 99%

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Yesterday, Today & Tomorrow: Best Practice for CSF Sampling of an EVD to Minimise Patient Risk

Crane

King²

2015

Australasian Journal of Neuroscience

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Managing raised intracranial pressure (ICP) with the use of an external ventricular drain (EVD) is a common occurrence in a neurosurgical setting. A central role of the neuroscience nurse in managing that EVD is to monitor the patient for signs and symptoms of infection otherwise known as ventriculitis. Cerebrospinal fluid (CSF) sampling from an EVD has historically been completed as a daily routine specimen to monitor for any signs of infection. However, in more recent times there has been evidence to suggest that specimens should only be collected when infection or ventriculitis is suspected to minimise the interruption of the closed system. Different practices have been identified related to the frequency of sampling, the best solution for decontamination of the sampling site/ port and preferable port for obtaining the specimen. Our aim was to complete an integrative literature review. Medline Complete and CINAHL were searched and articles were screened. Nine articles were used to form the integrated review. The main findings were collated and found that daily sampling is no longer recommended. The proximal port was the most popular choice for sampling. Decontaminating solutions used for accessing an EVD varied with no evidence to support the choice of solution. Findings of the majority of papers were focussed on sampling frequency and other associated ways to minimise infection rather than choice of sampling site or the use of specific decontaminating solutions.

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Section: Resultsunclassified

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Yesterday, Today & Tomorrow: Best Practice for CSF Sampling of an EVD to Minimise Patient Risk

Crane

King²

2015

Australasian Journal of Neuroscience

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“…The frequency of CSF sampling varies from scheduled collection daily (Bota, Lefranc, Vilallobos, Brimioulle, & Vincent, 2005;Kitchen et al, 2011;Schade et al, 2006); three times per week (Hoefnagel, Dammers, Ter Laak-Poort, & Avezaat, 2008;Williams, Leslie, Dobb, Roberts, & van Heerden, 2011); or collection only when needed for evaluation of fever, leukocytosis, headache, nuchal rigidity, or decline in neurologic status (Camacho et al, 2013;Chatzi et al, 2014;Dasic et al, 2006;Flint et al, 2013;Korinek et al, 2005;Leverstein-van Hall et al, 2010). To decrease risk of infection, sampling should only be performed on an as-needed basis.…”

Section: Hill Et Al 2012mentioning

confidence: 99%

Establishment of an External Ventricular Drain Best Practice Guideline

Hepburn-Smith¹,

Dynkevich

Spektor

et al. 2016

Journal of Neuroscience Nursing

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External ventricular drains (EVDs) are commonly used to facilitate removal of cerebrospinal fluid in patients with neurologic dysfunction. Despite a high risk for infection (upward of 45%), many hospitals lack strict protocols for EVD placement and maintenance. In addition, EVD infections are typically not tracked with the same diligence as central-line catheter infections, because there are no widely accepted standards for routine management of EVDs. The purpose of this review is to provide a guide for the development of a standardized, best practice EVD protocol for catheter insertion, care, and maintenance to reduce ventriculostomy-related infections. A secondary goal of this review is to provide support for the future development of guidelines for the consistent tracking of EVD insertion and maintenance practices.At an academic medical center, an interdisciplinary team of nurses, advanced practice nurses, and neurointensivists reviewed recent medical and nursing literature as well as research-based institutional protocols on EVD insertion and maintenance from the United States and abroad to determine global best practices. The goal of this literature review was to identify key areas of focus in EVD insertion and maintenance as well as to identify recent studies that have shown success in managing EVDs with low rates of infection. The following terms were used in this search: EVD, externalized ventricular drains, EVD infections, EVD insertion, EVD Care and Maintenance, Nursing and EVDS. The following databases were utilized by each member of the interdisciplinary team to establish a state of the science on EVD management: American Association of Neurosurgical Surgeons, CINAHL, Cochrane, National Guidelines Clearinghouse, and PubMed. The following common EVD themes were identified: preinsertion hair removal and skin preparation, aseptic technique, catheter selection, monitoring of EVD insertion technique using a "bundle" approach, postinsertion dressing type and frequency of dressing changes, techniques for maintenance and cerebrospinal fluid sampling, duration of catheter placement, staff education/competence, and surveillance.

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Central Nervous System Infections

Archibald

Quisling

2013

Textbook of Neurointensive Care

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External ventricular drain infection: improved technique can reduce infection rates

Cited by 63 publications

References 24 publications

Yesterday, Today & Tomorrow: Best Practice for CSF Sampling of an EVD to Minimise Patient Risk

Yesterday, Today & Tomorrow: Best Practice for CSF Sampling of an EVD to Minimise Patient Risk

Establishment of an External Ventricular Drain Best Practice Guideline

Central Nervous System Infections

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