External ventricular drainage cerebrospinal fluid collection [Neurosurgery Wiki]

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====== External ventricular drainage cerebrospinal fluid collection ======

If clinically indicated, the [[external ventricular drainage]] [[cerebrospinal fluid collection]] system may be accessed by [[physician]]s, and in some institutions, by [[nurse]]s,  [[withdraw]]ing [[CSF]] for the purposes of [[culture]]s and/or obtaining malignant cells, or to instill [[medication]]s
((Dey M, Jaffe J, Stadnik A, Awad IA. External ventricular drainage for intraventricular hemorrhage. Curr Neurol Neurosci Rep. 2012 Feb;12(1):24-33. doi: 10.1007/s11910-011-0231-x. PMID: 22002766; PMCID: PMC6777952.))
((Kocan MJ. Physicians are asking the nurses to irrigate ventriculostomy catheters. Crit Care Nurse. 2002 Dec;22(6):70-3. PMID: 12518572.))
((Wong FW. Cerebrospinal fluid collection: a comparison of different collection sites on the external ventricular drain. Dynamics. 2011 Fall;22(3):19-24. PMID: 21941814.)).

Spinal fluid samples are generally obtained through the proximal port (closest to the head) of the EVD collecting system and are performed using a strict [[sterile technique]] due to the risk of infection
((Dey M, Jaffe J, Stadnik A, Awad IA. External ventricular drainage for intraventricular hemorrhage. Curr Neurol Neurosci Rep. 2012 Feb;12(1):24-33. doi: 10.1007/s11910-011-0231-x. PMID: 22002766; PMCID: PMC6777952.)).

Samples should not be collected from the [[external ventricular drainage cerebrospinal fluid collection bag]] due to the rapid [[degradation]] of cellular components. Though samples can be drawn from the distal port, white cell counts and cultures are often not accurate
((Wong FW. Cerebrospinal fluid collection: a comparison of different collection sites on the external ventricular drain. Dynamics. 2011 Fall;22(3):19-24. PMID: 21941814.)).

When drawing the sample, aspiration should be very slow (no more than 1 ml/min) and if any resistance is met, the procedure should be aborted and a physician should be notified immediately. When medications are introduced into the EVD, such as tissue plasminogen activator for intraventricular hemorrhage
((Dey M, Jaffe J, Stadnik A, Awad IA. External ventricular drainage for intraventricular hemorrhage. Curr Neurol Neurosci Rep. 2012 Feb;12(1):24-33. doi: 10.1007/s11910-011-0231-x. PMID: 22002766; PMCID: PMC6777952.))
or antibiotics for ventriculitis
((Olson DM, Zomorodi M, Britz GW, Zomorodi AR, Amato A, Graffagnino C. Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage. J Neurosurg. 2013 Oct;119(4):974-80. doi: 10.3171/2013.6.JNS122403. Epub 2013 Aug 20. PMID: 23957382.))
the EVD should be clamped for 1 h after administration.