Failure of regular external ventricular drain exchange to reduce cerebrospinal fluid infection: result of a randomised controlled trial

Abstract

Background: It is controversial whether regular changes of external ventricular drains can reduce cerebrospinal fluid (CSF) infection. Objective: To carry out a randomised controlled clinical trial over a two year period to determine whether a regular change of ventricular catheter every five days could reduce CSF infection and improve outcome. Methods: 103 patients requiring external ventricular drains for more than five days and with no evidence of concurrent CSF infection were studied. The patients were randomised to regular change of ventricular catheter (every five days) and no change unless clinically indicated. Results: The CSF infection rates were 7.8% for the catheter change group and 3.8% for the no change group, respectively (rate ratio = 1.80, 95% confidence interval 0.33 to 9.81, p = 0.50). No significant difference was found in intensive care unit stay, ward stay, or clinical outcome between the two groups. Conclusions: Regular changes of ventricular catheter at five day intervals did not reduce the risk of CSF infection. A single external ventricular drain can be employed for as long as clinically indicated.

Infections of external ventricular drainages

“…We found that more frequent EVD replacements are associated with a higher infection rate. In concordance with our findings a study by Wong et al showed a higher risk for infections with multiple changes of EVDs [24]. According to some previously performed studies the most effective way is to change the EVD every five days after the procedure, as stated in the research by Mayhall et al [20].…”

Acute Hydrocephalus and Cerebral Perfusion after Aneurysmal Subarachnoid Hemorrhage

“…2 Besides a policy of wait and see, other treatment options are external drainage or (serial) lumbar puncture. [3][4][5] In patients who are not comatose, an initial policy of waiting for spontaneous recovery has been advocated 1 because external drainage carries a definite risk for complications such as infection [3][4][5][6] and is possibly associated with an increased risk of rebleeding, though not all studies agree. [7][8][9] However, hydrocephalus may decrease cerebral blood flow (CBF) by an increase of intracranial pressure, 10 even in patients who are awake.…”

External Ventricular Drain Infections

“…However, the review by Park et al on 595 patients with EVD insertions found that the daily infection rates would plateau after day 4 post-insertion, and remain steady beyond day 10 (Park, et al, 2004). In reported series that adopted the practice of regular elective EVD revisions, revisions were not found to decrease infection rate significantly, and may actually increase it (Lo, et al, 2007;Wong, et al, 2002). Current evidence indicates that although the duration of drainage is an independent risk factor for EVD-related infections, routine revision of EVD in the absence of other clinical indications is not recommended.…”