Ventriculostomy‐related Cerebrospinal Fluid Infections: The Effect of Catheter Exchange. A Randomized Controlled Clinical Trial

Abstract

Introduction: External ventricular drains (EVD) are used for intracranial pressure monitoring and temporary cerebrospinal fluid drainage in neurosurgery. Cerebrospinal fluid infection is the major complication. Previous prospective epidemiological study from Mayhall (1) had recommended that the EVD should be changed every 5 days to reduce CSF infection. However, subsequent different retrospective series had yielded conflicting results. Hypothesis: The aim was to test whether the practice of exchange of EVD every five days could reduce the CSF infection rate and subsequently improve outcome in terms of ICU stay, hospital stay, 3‐month outcome and mortality. Method: We carried out a randomized controlled clinical trial between 11/1998 and 11/2000. 103 patients who needed EVD for more than 5 days and had no evidence of CSF infection on presentation were included. The patients were randomized between change (every five days) and no change of external ventricular drain. Results: Conclusion: The practice of regular exchange of EVD did not reduce CSF infection rate and did not improve outcome. This is in agreement with the current thinking that CSF infection mainly originated from the procedure of ventriculostomy. The associated high cost with regular exchange of EVD (operations and new catheters) did not seem to be justified. Thus, the practice of regular exchange of EVD should be abandoned. (1) Ventriculostomy‐related infections: A prospective epidemiological study. Mayhall CG et al. New England of Journal of Medicine 310(9): 553–559, 1984.