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H E A L T H

Intensive Care
Evidence Based Practice Guidelines
2003

Cerebrospinal Fluid Drainage/External Ventricular Drain (EVD)

Indications:
to lower intracranial pressure through intermittent or continuous drainage of cerebrospinal fluid (CSF)

Contraindications:
measuring the ICP (temporarily only) following administration of intrathecal medications

Complications: infection excessive or inadequate drainage of CSF due to incorrect height of drainage burette,
disconnection or dislodgment of EVD, CSF leak around drain entry site inaccurate monitoring of intracranial pressure (drain must be closed when measuring ICP)

Equipment: EVD with pressure tubing connected to monitor and drainage system measuring tape marked in centimetres carpenters spirit level doctors order for CSF drainage and level of ICP at which to initiate drainage.

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H E A L T H

Intensive Care Evidence Based Practice Guidelines 2003

CSF Drainage/EVD

Procedure:

Position the patient with the head of the bed elevated 30 45 o or as ordered Level the transducer to the tragus (external auditory meatus) Position the top of the drainage set at the centimentre level ordered by the neurosurgeon. This is usually 5-20 cm above the level of the tragus. To determine the level required, place a tape measure on an IV pole. Measure upward from the level of the transducer on the IV pole, to the centimetre level ordered, then mark this point. Secure the burette to the IV pole with the pressure line on the top of the burette level with the marked point. Document the predrainage ICP Turn the stopcock ON to the ventricular catheter and drainage system. Leave the stopcock in this position for the length of time ordered by the MO, to allow CSF to drain. Observe the burette for CSF dripping. If dripping is not present, check the position of the stopcock. If the stopcock is in the correct position and dripping of CSF is not observed, notify the MO. During drainage, the waveform on the monitor does not reflect ICP.

Nursing Care:
The EVD should only be CLAMPED if: it is ordered by the MO measuring the ICP (temporarily only). Obtain hourly ICP readings by turning the stopcock OFF to drainage and ON to the ventricular catheter and transducer. After observing ICP waveform and obtaining a reading, turn stopcock ON to drainage. following administration of intrathecal medications obtaining a CSF specimen. Record ICP hourly with stopcock OFF to drainage to take measurement. Record amount of drainage hourly Any time the level of the patients head is altered in relation to the drip chamber, turn the stopcock OFF to drainage until the prescribed level can be re-established. The length of time that the drain is clamped should be kept to a minimum in drainage-dependent patients. Maintain a dry occlusive dressing over EVD insertion site.

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H E A L T H
CSF Drainage/EVD

Intensive Care Evidence Based Practice Guidelines 2003

References: 1. Kirkness C, Mitchell P, Burr R, March K & Newell D. (2000). Intracranial Pressure Waveform Analysis:Clinical and Research Implications. J Neuroscience Nursing October 2000, 32(5):271-277. 2. March K. (2000). Intracranial Pressure Monitoring and Assessing Intracranial Compliance in Brain Injury. Critical Care Nursing Clinics of North America 12(4): 429-436. 3. Mims B, Toto K, Luecke L & Roberts M. (1996). Critical Care Skills- A Clinical Handbook. W.B. Saunders Co. Philadelphia. 4. Pope W.(1998). External Ventriculostomy:Apractical Application for the Acute Care Nurse. J Neuroscience Nursing.30(3): 185-190. 5. Stewart-Amidei C. (1998). Neurologic Monitoring in the ICU. Critical Care Quarterly 21(3):47-60 6. Woodward S, Addison C, Shah S, Brennan F, MacLeod A, Clements M. (2002) Benchmarking best practice for external ventricular drainage. British Journal of Nursing 11(1):4753.

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