The placement of an external ventricular drain (EVD) or a lumbar drain (LD) is only the first part of the procedures involving these drains. Both the EVD and the LD require continual care and attention. The cerebrospinal fluid (CSF) collection chamber of each drain must be maintained appropriately. Doing so allows for accurate measurement of intracranial pressure and other parameters. When needed, the catheters can be accessed to draw CSF or instill medications. Transporting a patient with either an EVD or an LD in place should be well planned, and providers should be alert for a CSF leak or drain pullout. The duration of use of either drain should be as brief as possible.
In this chapter, we cover the maintenance of the external ventricular drain (EVD) and the lumbar drain (LD) after placement. We also describe how to troubleshoot problems with the drains that may arise. Many of the concepts for EVDs are also applicable to LDs; thus, in the sections on LDs we address only the differences in postplacement care for LDs.
After the EVD has been placed, but before the sterile drapes are taken down, a dressing is placed over the site of the drain. Practices vary with regard to the type of dressing and how often it should be changed. Some authors recommend an occlusive dressing, whereas others recommend a nonocclusive dressing. A randomized controlled trial showed that dressings containing chlorhexidine reduced subcutaneous colonization of EVDs.1
Although consensus statements have not given definitive recommendations for EVD dressing, we suggest using a BioPatch (Ethicon; Johnson & Johnson) at the drain exit point. The fine hair that remains on the skin after clipping makes an occlusive dressing difficult to maintain. We prefer a sterile gauze drain sponge (Fig. 5.1). Neuroscience nursing assessment is performed at least every 2 to 4 hours to ensure that the sponge has not become saturated with cerebrospinal fluid (CSF). The dressing should be changed every 3 days or whenever it becomes soiled or dislodged. The BioPatch dressing is replaced at least every 7 days. Replacement should be performed in a sterile manner using sterile gloves and sterile sponges. Hair around the area of the drain should be kept short (but not shaved) until the drain is removed.
External ventricular drain (EVD) dressing. The types of dressing used at our institutions for EVDs are a BioPatch covered by a sterile gauze dressing taped on all four sides. To facilitate an appropriate changing schedule, we write the date the dressing was placed and the name of the provider who placed it on the dressing itself. This dressing also helps to mark the boundaries for where electroencephalogram electrodes can be placed on the scalp.