title: Placement of external ventricular drains and intracranial pressure monitors by neurointensivists.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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 cm(3).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Neurological Critical Care Unit, Via Christi Regional Medical Center, 929 N. St. Francis, Wichita, KS 67214, USA. aehtisham@kumc.edu
authors.forename: As'ad
authors.initials: A
authors.lastname: Ehtisham
authors.forename: Scott
authors.initials: S
authors.lastname: Taylor
authors.forename: Linda
authors.initials: L
authors.lastname: Bayless
authors.forename: Michael W
authors.initials: MW
authors.lastname: Klein
authors.forename: Jeff M
authors.initials: JM
authors.lastname: Janzen
mesh_terms: D000328:Adult; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007427:Intracranial Pressure; D008297:Male; D008511:Medicine / Q000592:standards*; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000009:adverse effects / Q000379:methods*; D009493:Neurosurgery / Q000592:standards; D012189:Retrospective Studies; D012449:Safety; D013038:Specialization; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult