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Externalized Ventriculostomy Drains

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https://www.readbyqxmd.com/read/29097331/infection-incidence-associated-with-external-ventriculostomy-placement-a-comparison-of-outcomes-in-the-ed-icu-and-or
#1
Gurkirat Kohli, Roshansa Singh, Yehuda Herschman, Antonios Mammis
OBJECTIVE: External ventricular drain (EVD) placement is a common neurosurgical procedure used to control acute hydrocephalus and other neurosurgical complications. The infection and complication rates reported in the literature are highly variable and iatrogenic factors determine the outcome of drain placement. We examined the impact of the setting of the EVD placement (ED vs. ICU vs. OR) and the experience of the operating surgeon on the infection rate, complication rate, EVD replacement, eventual placement of VP shunt and need for further surgical intervention...
October 30, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29088955/real-time-ultrasound-guided-external-ventricular-drain-placement-technical-note
#2
James H Manfield, Kenny K H Yu
In the United Kingdom, ultrasound-guided external ventricular drain (EVD) insertion is becoming the standard of care to mitigate the morbidity associated with catheter malposition and multiple passes. Many neurosurgeons routinely use ultrasound to check the preinsertion trajectory, although real-time visualization of ventricular cannulation is preferable since minor deviations can be significant in patients with smaller ventricles, and live visualization further enables the catheter tip to be adjusted away from the choroid plexus...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28905331/antibiotic-distribution-into-cerebrospinal-fluid-can-dosing-safely-account-for-drug-and-disease-factors-in-the-treatment-of-ventriculostomy-associated-infections
#3
Nilesh Kumta, Jason A Roberts, Jeffrey Lipman, Menino Osbert Cotta
Ventriculostomy-associated infections, or ventriculitis, in critically ill patients are associated with considerable morbidity. Efficacious antibiotic dosing for the treatment of these infections may be complicated by altered antibiotic concentrations in the cerebrospinal fluid due to variable meningeal inflammation and antibiotic properties. Therefore, doses used to treat infections with a higher degree of meningeal inflammation (such as meningitis) may often fail to achieve equivalent exposures in patients with ventriculostomy-associated infections such as ventriculitis...
September 13, 2017: Clinical Pharmacokinetics
https://www.readbyqxmd.com/read/28789958/diagnosis-of-ventriculostomy-related-infection-is-cerebrospinal-fluid-lactate-measurement-a-useful-tool
#4
Pedro Grille, Federico Verga, Alberto Biestro
OBJECTIVE: To evaluate the value of CSF lactate (LCSF) for the diagnosis of ventriculostomy related infections (VRI), and compare it with other CSF markers. METHODS: Prospective study of neurocritical patients admitted to Maciel Hospital and Clinicas Hospital ICUs in which an external ventricular drain (EVD) was inserted. In patients with clinical suspicion of VRI, a CSF sample was obtained through the EVD for CSF culture and markers analysis (glucose, protein, lactate and leukocytes)...
November 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28716567/moving-the-goalposts-a-comparison-of-different-definitions-for-primary-external-ventricular-drain-infection-and-its-risk-factors-a-multi-center-study-of-2575-patients
#5
Peter Y M Woo, Hoi-Tung Wong, Jenny K S Pu, Wai-Kei Wong, Larry Y W Wong, Michael W Y Lee, Kwong-Yui Yam, Wai-Man Lui, Wai-Sang Poon
External ventricular drainage is the most common procedure performed in daily neurosurgical practice. One devastating complication is ventriculostomy-associated infection, but the establishment of evidence-based management guidelines has been hindered by the lack of an universal definition. There is also limited data with regard to the utility of comorbidity health indices and surgery-related factors in predicting infection. This study aims to compare the incidence of infection according to five commonly used definitions and to identify risk factors for this complication...
November 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28713628/outcomes-of-post-neurosurgical-ventriculostomy-associated-infections
#6
Muhammad E Bari, Ghani Haider, Komail Malik, Muhammad Waqas, Syed F Mahmood, Mubbashira Siddiqui
BACKGROUND: Ventriculostomy-associated infection (VAI) is a major concern to physicians. Limited studies have looked at the outcomes of external ventricular drain (EVD) infection and predictors of unfavorable outcomes. In this study, we assessed the outcomes of EVD infection and predictors of unfavorable outcomes. METHODS: This was a retrospective medical chart review, conducted at the Aga Khan University Hospital. All the patients irrespective of age and gender, fulfilling the diagnostic criteria of VAI were included...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28708018/endoscopic-third-ventriculostomy-and-repeat-endoscopic-third-ventriculostomy-in-pediatric-patients-the-dutch-experience
#7
MULTICENTER STUDY
Gerben E Breimer, Ruben Dammers, Peter A Woerdeman, Dennis R Buis, Hans Delye, Marjolein Brusse-Keizer, Eelco W Hoving
OBJECTIVE After endoscopic third ventriculostomy (ETV), some patients develop recurrent symptoms of hydrocephalus. The optimal treatment for these patients is not clear: repeat ETV (re-ETV) or CSF shunting. The goals of the study were to assess the effectiveness of re-ETV relative to initial ETV in pediatric patients and validate the ETV success score (ETVSS) for re-ETV. METHODS Retrospective data of 624 ETV and 93 re-ETV procedures were collected from 6 neurosurgical centers in the Netherlands (1998-2015)...
October 2017: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/28614970/effect-of-cerebrospinal-fluid-drainage-on-brain-tissue-oxygenation-in-traumatic-brain-injury
#8
Omar S Akbik, Mark Krasberg, Edwin M Nemoto, Howard Yonas
The effectiveness of cerebrospinal fluid (CSF) drainage in lowering high intracranial pressure (ICP) is well established in severe traumatic brain injury (TBI). Recently, however, the use of external ventricular drains (EVDs) and ICP monitors in TBI has come under question. The aim of this retrospective study was to investigate the effect of CSF drainage on brain tissue oxygenation (PbtO2). Using a multi-modality monitoring system, we continuously monitored PbtO2 and parenchymal ICP during CSF drainage events via a ventriculostomy in 40 patients with severe TBI...
November 15, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28612132/hemorrhage-rate-after-external-ventricular-drain-placement-in-subarachnoid-hemorrhage-time-to-heparin-administration
#9
Andrew P Gard, Brian D Sayles, J Will Robbins, William E Thorell, Daniel L Surdell
OBJECTIVE: The use of antiplatelet or anticoagulants has previously been shown to increase hemorrhagic complications of ventricular catheterization. Although heparin use 24 h after ventriculostomy appears safe, the safety of heparin immediately (within 4 h) after ventriculostomy is unknown. The objective of this study was to assess the safety of heparin immediately (within 4 h) after ventriculostomy in subarachnoid hemorrhage (SAH) patients undergoing endovascular treatment. PATIENTS AND METHODS: This is a retrospective cohort study of 46 patients with aneurysmal SAH secondary to aneurysm rupture who required ventriculostomy...
June 13, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28549914/timing-of-permanent-ventricular-shunt-placement-following-external-ventricular-drain-placement-in-primary-intracerebral-hemorrhage
#10
Steven Ray Peters, David Tirschwell
BACKGROUND: Intraventricular hemorrhage requiring ventriculostomy placement is a frequent complication of spontaneous intracerebral hemorrhage. Although a subset of patients will require permanent ventricular shunt placement, little is known about contemporary practices regarding the timing of ventriculostomy and ventricular shunt placement after intracerebral hemorrhage. METHODS: Using the 2010-2012 National Inpatient Sample, we identified patients with International Classification of Diseases, Ninth Revision codes for intracerebral hemorrhage, excluded secondary causes, and examined procedure dates...
October 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28405540/markedly-improved-success-rate-of-endoscopically-assisted-third-ventriculostomy-is-achieved-by-routine-placement-of-external-lumbar-drain
#11
Justen Watkins, Marc Cabanne, Dan Miulli
Hydrocephalus is a major cause of patient decreased quality of life and high health care financial burden in the United States and throughout the world. The placement of ventricular shunts (ventriculoperitoneal shunt) has proven to be a safe treatment for hydrocephalus, but it is associated with a high complication rate leading to a lower quality of life and continued financial burden for patients, their families, and society as a whole. The endoscopically assisted third ventriculostomy (ETV) has been practiced as an alternative to ventricular shunting since the 1990s...
April 2017: Journal of Neurological Surgery Reports
https://www.readbyqxmd.com/read/28219470/comparing-external-ventricular-drains-related-ventriculitis-surveillance-definitions
#12
COMPARATIVE STUDY
Maria M Reyes, Satish Munigala, Emily L Church, Tobias B Kulik, Salah G Keyrouz, Gregory J Zipfel, David K Warren
OBJECTIVE To evaluate the agreement between the current National Healthcare Safety Network (NHSN) definition for ventriculitis and others found in the literature among patients with an external ventricular drain (EVD) DESIGN Retrospective cohort study from January 2009 to December 2014 SETTING Neurology and neurosurgery intensive care unit of a large tertiary-care center PATIENTS Patients with an EVD were included. Patients with an infection prior to EVD placement or a permanent ventricular shunt were excluded...
May 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28180053/isolated-spontaneous-midbrain-hemorrhage-in-a-14-year-old-boy
#13
Kim-Long R Nguyen, Hyunyoung Kim, Laszlo Nagy
Isolated spontaneous midbrain hemorrhages are rare because they are usually secondary to hemorrhages from inferior structures such as the pons and cerebellum, or superior structures such as the thalamus and putamen. While the etiologies are largely unidentified, the most common ones are vascular malformations and bleeding diathesis with hypertension being relatively uncommon. We report midbrain hemorrhage in a 14-year-old boy with a long-standing history of frequent migraine headaches and attention deficit/hyperactivity disorder (ADHD)...
January 2017: Journal of Neurological Surgery Reports
https://www.readbyqxmd.com/read/28042365/variations-in-strategies-to-prevent-ventriculostomy-related-infections-a-practice-survey
#14
Ariane Lewis, Barry M Czeisler, Aaron S Lord
BACKGROUND AND PURPOSE: The ideal strategy to prevent infections in patients with external ventricular drains (EVDs) is unclear. METHODS: We conducted a cross-sectional survey of members of the Neurocritical Care Society on infection prevention practices for patients with EVDs between April and July 2015. RESULTS: The survey was completed by 52 individuals (5% response rate). Catheter selection, use of prolonged prophylactic systemic antibiotics (PPSAs), cerebrospinal fluid (CSF) collection policies, location of EVD placement, and performance of routine EVD exchanges varied...
January 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28034809/trends-in-ventriculostomy-associated-infections-and-mortality-in-aneurysmal-subarachnoid-hemorrhage-data-from-the-nationwide-inpatient-sample
#15
Roy Poblete, Ling Zheng, Ranjita Raghavan, Steven Cen, Arun Amar, Nerses Sanossian, William Mack, May Kim-Tenser
BACKGROUND: Patients with aneurysmal subarachnoid hemorrhage (aSAH) are susceptible to various medical complications, including ventriculostomy-associated infections (VAIs) in those who undergo external ventricular drain (EVD) placement. Many preventative strategies for VAIs have been used during the last 20 years, but their overall effect is unknown. Using the Nationwide (National) Inpatient Sample, we examined trends in VAI rates and mortality during a recent 12-year period in the aSAH population...
March 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28000128/hemorrhagic-complications-associated-with-ventriculostomy-in-patients-undergoing-endovascular-treatment-for-intracranial-aneurysms-a-single-center-experience
#16
Jack M Leschke, Andrew Lozen, Mayank Kaushal, Akinwunmi Oni-Orisan, Mazen Noufal, Osama Zaidat, Glen A Pollock, Wade M Mueller
BACKGROUND: Currently, a complete understanding of post-ventriculostomy hemorrhagic complications in subarachnoid hemorrhage due to ruptured aneurysms remains unknown. The present study evaluates the impact of periprocedural risk factors on rates of external ventricular drain (EVD)-associated hemorrhage in the setting of endovascular treatment of intracranial aneurysms. METHODS: A retrospective chart review of 107 patients who underwent EVD placement within 24 h of endovascular coiling was performed...
August 2017: Neurocritical Care
https://www.readbyqxmd.com/read/27825904/ruptured-massa-intermedia-secondary-to-hydrocephalus
#17
Ahmed El Damaty, Soenke Langner, Henry W S Schroeder
BACKGROUND: We report a case of ruptured massa intermedia (MI) as a sequela of hydrocephalus. CASE DESCRIPTION: A single case report is presented describing the sequelae of tumor bed hematoma after a posterior fossa hemangioblastoma resection in which the patient bled 3 days after surgery, resulting in secondary hydrocephalus and subsequently dilatation of the third ventricle, which resulted in rupture of the MI. The patient was managed on emergency basis with an external ventricular drain then endoscopically with a third ventriculostomy and clot extraction...
January 2017: World Neurosurgery
https://www.readbyqxmd.com/read/27751614/rates-of-iatrogenic-ventriculitis-before-and-after-the-use-of-an-alcohol-impregnated-external-ventricular-drain-port-cap
#18
Zachary D Levy, David E Ledoux, Martin L Lesser, Timothy White, Jaclyn M Rosenthal, Marguerite Johnson, Gunes A Aygok
Iatrogenic ventriculitis is a potential complication of ventriculostomy drain placement. In this study, an alcohol-impregnated external ventricular drain port cap was added to a standardized ventriculostomy placement bundle. Rates of ventriculitis were reduced postintervention, but this finding did not reach statistical significance.
January 1, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/27729301/small-versus-large-catheters-for-ventriculostomy-in-the-management-of-intraventricular-hemorrhage
#19
MULTICENTER STUDY
Vianney Gilard, Ben Ousmanou Djoubairou, Arnaud Lepetit, Thomas Metayer, Clement Gakuba, Charlotte Gourio, Stephane Derey, François Proust, Evelyne Emery, Thomas Gaberel
OBJECTIVE: Intraventricular hemorrhage (IVH) often requires the insertion of an external ventricular drain (EVD), but blood clots could occlude the catheters. Large EVD catheters may help to reduce the risk of catheter occlusion. Here, we compared small catheters with large catheters for ventriculostomy in patients suffering from IVH. METHODS: We conducted a retrospective cohort study. Patients were included if they had IVH requiring EVD insertion. We then compared baseline characteristics and outcomes of patients treated with large catheters with patients treated with small catheters...
January 2017: World Neurosurgery
https://www.readbyqxmd.com/read/27324657/fewer-complications-with-bolt-connected-than-tunneled-external-ventricular-drainage
#20
COMPARATIVE STUDY
Torben Slott Jensen, Jakob Gram Carlsen, Jens Christian Sørensen, Frantz Rom Poulsen
BACKGROUND: Ventriculostomy/external ventricular drain (EVD) is a common neurosurgical procedure. Various techniques are used to fixate the drain and the objective of this study was, in a retrospective setting, to compare the incidence of complications when using bolt-connected EVD (BC-EVD) versus tunneled EVD (T-EVD). METHODS: All patients subjected to an EVD performed through a new burr hole from 2009 through 2010 at two Depts. of Neurosurgery in Denmark (Odense and Aarhus) were retrospectively identified...
August 2016: Acta Neurochirurgica
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