Technical Note: External Cerebrospinal Fluid (CSF) Drainage by Percutaneous Needle Punction in Newborn Children

Abstract

External drainage of CSF in children is indicated in acute hydrocephalus e.g. after intraventricular bleeding or infection. In these cases the drainage has to remain in place until physiological CSF circulation is restored or an internal shunt can be inserted. External drainage is mostly performed using a silicon catheter connected to a plastic bag. An external CSF drainage left for several days in situ bears an increasing risk of bacterial infection. In these cases a metal needle minimizes the risk of ventriculitis. For prevention of accompanying infection we implanted a Cytocan port needle with a 20 G diameter in 7 infants. The needle is easily inserted with low risk of complications. By its plastic top angulated at 90 degrees to the needle the system can be fixed to the skin very safely by suture or tape. With this system neither an implantation related intracerebral haemorrhage nor an accompanying ventriculitis was encountered. In two cases a pre-existing ventriculitis was cured by this needle drainage and antibiotic treatment. In five cases an acute hydrocephalus after intraventricular haemorrhage was drained by the port needle system.

Metal external ventricular drainage catheters in the treatment of persistent ventriculitis - an old story made new. technical note and preliminary results

“…Mean operating time for the procedure including fixation and connection to the drainage system was 27 minutes (range [25][26][27][28][29][30]. In all three patients 5mg=150,000 IU/day Colistin/Norma ® (polymyxin E) (colistin mesilate sodium 1,000,000 IU/vial, Norma Hellas S.A., Greece) were injected intrathecally via the EVD catheter for 3 weeks (12).…”

“…Catheter-associated infection of the cerebrospinal fluid (CSF) is a well-known and eventually devastating complication of external ventricular drainage (EVD) (2,13). The infection rate can be as high as 30% and increases three-fold more than 18 days after implantation of conventional (silicon) catheters (23,25). Even though it is standard practice to administer antibiotics prophylactically (15), the CSF infection cannot be totally excluded (13,25).…”

“…The infection rate can be as high as 30% and increases three-fold more than 18 days after implantation of conventional (silicon) catheters (23,25). Even though it is standard practice to administer antibiotics prophylactically (15), the CSF infection cannot be totally excluded (13,25). On the other hand, the average infection rate of ventriculostomy via metal needles has been reported to be less than 1% (18).…”

“…In order to minimize the risk of ventriculitis several approaches have been proposed both for adults (9,13,17,21) and children (20,22,24,25); percutaneous needle puncture (25), 'Duisburger Nadel' (10), endoscopic third ventriculostomy alone or combined with choroid plexus (24), antibiotic-impregnated catheters (AIC) (17,21,22), nanoparticles (silver)-impregnated catheters (9,13) and flexible metal ventricular catheters (23) represent only some of the current practices. In the case of verified ventriculitis the choice of the appropriate catheter to use is far more troublesome.…”

“…The scope of this report is to highlight the enhanced therapeutic potential of metal catheters as compared to the conventional (silicon) ones in selected cases of protracted ventriculitis in patients with extended length of stay in an intensive care unit (ICU). To the authors' knowledge there are only 2 articles in the English literature commenting on the superiority of a metal catheter in treating complicated infection of the ventricles (23,25). The efficacy of colistin in eradicating multidrug-resistant bacteria such as Acinetobacter baumannii is additionally underlined (7,12).…”