title: The Insertion and Management of External Ventricular Drains: An Evidence-Based Consensus Statement : A Statement for Healthcare Professionals from the Neurocritical Care Society.
abstract: External ventricular drains (EVDs) are commonly placed to monitor intracranial pressure and manage acute hydrocephalus in patients with a variety of intracranial pathologies. The indications for EVD insertion and their efficacy in the management of these various conditions have been previously addressed in guidelines published by the Brain Trauma Foundation, American Heart Association and combined committees of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. While it is well recognized that placement of an EVD may be a lifesaving intervention, the benefits can be offset by procedural and catheter-related complications, such as hemorrhage along the catheter tract, catheter malposition, and CSF infection. Despite their widespread use, there are a lack of high-quality data regarding the best methods for placement and management of EVDs to minimize these risks. Existing recommendations are frequently based on observational data from a single center and may be biased to the authors' view. To address the need for a comprehensive set of evidence-based guidelines for EVD management, the Neurocritical Care Society organized a committee of experts in the fields of neurosurgery, neurology, neuroinfectious disease, critical care, pharmacotherapy, and nursing. The Committee generated clinical questions relevant to EVD placement and management. They developed recommendations based on a thorough literature review using the Grading of Recommendations Assessment, Development, and Evaluation system, with emphasis placed not only on the quality of the evidence, but also on the balance of benefits versus risks, patient values and preferences, and resource considerations.
authors.affiliation: University of Colorado and Denver Health Medical Center, Denver, CO, USA.
authors.forename: Herbert I
authors.initials: HI
authors.lastname: Fried
authors.affiliation: University of Virginia, Charlottesville, VA, USA. brn3a@virginia.edu.
authors.forename: Barnett R
authors.initials: BR
authors.lastname: Nathan
authors.affiliation: College of Pharmacy, University of Tennessee Health Science Center, Knoxville, TN, USA.
authors.forename: A Shaun
authors.initials: AS
authors.lastname: Rowe
authors.affiliation: Barrow Neurological Institute, Phoenix, AZ, USA.|Scottsdale Osborn Medical Center, Scottsdale, AZ, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Zabramski
authors.affiliation: University of Cincinnati College of Medicine, University of Cincinnati Neuroscience Institute and Mayfield Clinic, Cincinnati, OH, USA.
authors.forename: Norberto
authors.initials: N
authors.lastname: Andaluz
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Adarsh
authors.initials: A
authors.lastname: Bhimraj
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Mary McKenna
authors.initials: MM
authors.lastname: Guanci
authors.affiliation: Department of Critical Care Services, Maine Medical Center, Portland, ME, USA.|Tufts University School of Medicine, Boston, MA, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Seder
authors.affiliation: Department of Medicine, University of Toronto and Krembil Neuroscience Centre, Toronto Western Hospital, Toronto, Canada.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Singh
mesh_terms: D032921:Consensus; D003422:Critical Care / Q000592:standards*; D004322:Drainage / Q000592:standards*; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D009462:Neurology / Q000592:standards*; D012955:Societies, Medical / Q000592:standards*; D014696:Ventriculostomy / Q000592:standards*
keywords: Antibiotic coated catheter; Antibiotic prophylaxis; Antibiotics; Antimicrobial coated catheter; CSF drainage; DVT; DVT prophylaxis; Deep venous thrombosis; EVD; External ventricular drain; Hemorrhage; Hydrocephalus; ICP; Intraventricular antibiotics; Monitoring; Thromboembolism; VAI; VRI; Ventriculostomy; Ventriculostomy associated infection; Ventriculostomy-related infection