Resources
Humphrey, E. (2018, March 26). Caring
for neurosurgical patients with external
ventricular drains. Retrieved August 3,
2019, from
https://www.nursingtimes.net/clinicalarchive/neurology/caring-forneurosurgical-patients-with-externalventricular-drains/7023833.article
O'Connor, J. (2015, April 28). External
ventricular drainage. Retrieved August
3, 2019, from
https://www.gosh.nhs.uk/healthprofessionals/clinicalguidelines/external-ventriculardrainage
Pfisterer, W., & Reinprecht. (2003, July
01). Early diagnosis of external
ventricular drainage infection: Results of
a prospective study. Retrieved August 3,
2019, from
https://jnnp.bmj.com/content/74/7/92
9
EXTERNAL
VENTRICULAR
DEVICE
U. (2017, February). Ventriculostomy.
Retrieved August 3, 2019, from
https://www.uwhealth.org/healthfac
ts/neuro/6563.pdf
Katelyn Story
Figure A: Normal CSF; Figure B: Hydrocephalus
External Ventricular
Device
What is it?
Procedure
The procedure takes less than an hour and does not
require general anesthesia. Local anesthetic is used.
Medication will be used if needed to prevent pain.
1. A small area of the head will be shaved
and cleaned.
2. A cloth drape will be placed over the
head to keep the area sterile.
3. After numbing the scalp, the doctor will
make a small hole in the top of the head.
Then, a narrow plastic tube will be placed
into the ventricle of the brain.
4. This tube is connected to a drainage bag
and monitoring system allowing the
healthcare team to observe the head
pressures and drain off excess fluid from
the brain as needed.
5. The tube will be held in place with some
stitches. It may be covered with a sterile
bandage to keep it clean.
EVD placement should be reviewed on Day 10.
After this time the entire system may need to be
removed or changed or the physician may decide
to leave it in longer.
Post-operatively, the nurse will assess and
observe for any CSF leak from the wound site and
carry out neurological observations between one
to four hourly as appropriate.
An external ventricular device (EVD) is a
closed external system connected to a
lateral ventricle in the brain to drain
excess cerebrospinal fluid (CSF), which
decreases intracranial pressure (ICP) on
the brain.
Why is it needed?
Increased ICP is considered a medical
emergency. It can happen to someone
with hydrocephalus, hemorrhage,
tumors, meningitis or traumatic brain
injuries. Left untreated, an increase in
pressure may lead to brain injury,
seizure, stroke, coma, or death. With
prompt treatment, it is possible for
people with increased ICP to make a full
recovery.
What are the risks? Complications?
Common complications include
hemorrhage, inadvertent placement into
brain tissue, infection, and obstruction
from cellular tissue due to the invasive
nature of the device.
Nursing Diagnoses
Risk for infection related to invasive
procedure.
Acute pain related to wound as evidence
by guarding behavior and restlessness.
What is zeroing and why do they keep
doing that every time my baby moves
her head?
The scale on the EVD have positive and
negative measurements; zero
corresponds to the pressure where the
catheter enters the ventricle, and should
always be horizontal to the tragus of the
baby’s ear. So, when the baby moves, the
scale is knocked out of alignment with
the ear and the pressure may not be the
correct number.
When you draw fluid from the lines,
what are you looking for?
We are looking for cloudiness or tissue
debris in the CSF, which indicates
infection.
How will my baby be monitored for
infection?
We are looking for cloudy CSF, excessive
drainage on bandage, a high white blood
cell count, and an elevated body
temperature.
How can my I prevent my baby from
getting an infection?
Do not touch the tube while it is in place,
inform the nurse if the child moves (we
have to clamp the drain and adjust the
level of the system first) and regular
handwashing for the parents and all
visitors.