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Placement of External Ventricular Drains and Intracranial Pressure Monitors by Neurointensivists

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Abstract

Introduction

External ventricular drains (EVDs) and intracranial pressure (ICP) monitors are widely used in the Neurological Critical Care Unit (NCCU) to measure ICP and divert cerebrospinal fluid (CSF). EVDs and ICP monitors have historically been placed by neurosurgeons; however, with recent staffing of NCCUs by neurointensivists, a growing number of EVDs and ICP monitors are being placed by these specialists.

Results

Limited data are available concerning the safety or feasibility of such placements by neurointensivists. We present our experience with EVD and ICP monitor placement by a neurointensivist in the NCCU. A retrospective chart review of 29 patients with EVD placement and 7 patients with ICP monitors—all placed by a single neurointensivist—was conducted for patients admitted to the NCCU from August 2005 to January 2008.

Discussion

These findings were compared to published outcomes from neurosurgeon placements. All 29 patients with EVDs remained infection-free, with CSF pleocytosis occurring in one patient (3.4%). All 7 patients receiving ICP monitors remained free from infection. Complications after drain placement occurred in 20.7% (n = 6) of patients, with all six complications being EVD tract hematoma measuring less than 5 cm3.

Conclusion

Patients receiving ICP monitors had no complications. These complication rates are comparable to published rates, which suggest that placement of EVDs and ICP monitors by neurointensivists may be safe and effective. However, small sample size (n = 36) prohibits definitive safety and efficacy conclusions. For this reason, further research analyzing a larger patient sample is warranted.

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Authors and Affiliations

  1. Neurological Critical Care Unit, Via Christi Regional Medical Center, 929 N. St. Francis, Wichita, KS, 67214, USA

    As’ad Ehtisham & Linda Bayless

  2. Department of Internal Medicine—Neurology, University of Kansas School of Medicine, Wichita, KS, USA

    As’ad Ehtisham

  3. Department of Pharmacy, Via Christi Regional Medical Center, Wichita, KS, USA

    Scott Taylor

  4. Department of Research, Via Christi Regional Medical Center, Wichita, KS, USA

    Michael W. Klein & Jeff M. Janzen

Authors
  1. As’ad Ehtisham
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  2. Scott Taylor
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  3. Linda Bayless
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  5. Jeff M. Janzen
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Correspondence to As’ad Ehtisham.

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Ehtisham, A., Taylor, S., Bayless, L. et al. Placement of External Ventricular Drains and Intracranial Pressure Monitors by Neurointensivists. Neurocrit Care 10, 241–247 (2009). https://doi.org/10.1007/s12028-008-9097-4

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