external_ventricular_drainage_cerebrospinal_fluid_collection_sterile_technique [Neurosurgery Wiki]

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Dressing changes

Dressings of the EVD site need to be observed hourly and this documented to ensure a leak has not occurred. If a leak is identified, place pressure combine/dressing and notify the AUM and Neurosurgical team. Dressings should be changed using sterile technique when soiled or otherwise directed by the Neurosurgical Medical team. 

Changing the EVD system set 
The entire system needs to be changed using sterile technique every 7 days. The procedure will require 2 registered nurses who are competent and confident with this procedure.

Equipment

x2 Sterile dressing pack 
Sterile gloves 
Extra Gauze 
Surgical steel clamp 
Chlorhexidine 0.5% in Alcohol 70% solution 
Medtronic Exacta EVD Kit (Stores Number: 309634) 
x2 Sterile Integra Stopcock protection boxes (External reference number: 901400)
30mls 0.9% Normal Saline
x1 10mL syringe 
x1 30mL syringe 
Drawing up needle 
BetadineÔ (iodine 1%) solution
Procedure

Link: Aseptic Technique Policy & Procedure (RCH access only) 

Explain to the patient/ family what is about to occur 
Perform Hand Hygiene 
Clean trolley/work surface with detergent and water or impregnated wipes 
Identify and collect all equipment for procedure 
Perform Hand Hygiene 
Open sterile dressing pack by using corners, ensure opened out to one end of trolley/work surface  
Open second dressing pack out on remainder of work surface/trolley to provide large sterile field 
Peel open sterile equipment and drop onto sterile field using non-touch technique 
Perform Clinical/Procedural Hand and don sterile gloves 
- Perform procedure ensuring all key parts are protected 
- Sterile items are used once and disposed of into waste bag 
- Only sterile key parts should contact disinfected or sterile key sites 
- Sterile items should not come into contact with non-sterile items 
Operator RN to prime Medtronic Exacta EVD kit with 0.9% Normal Saline commencing at the patient line towards the short section of tubing (the end that connects to the ventricular catheter) 
Rotate the patient line 3-way stopcock 180° so fluid can be pushed in the direction of the drip chamber, prime the patient line all the way through to the drip chamber 
Ensure all 3-way taps are primed and the system has no air in it 
Fill Integra Stopcock protection boxes with Betadine (iodine 1%) solution using a 10mL syringe 
Assistant RN to clamp/turn off the EVD and remove old Integra Stopcock protection box closest to the patient and hold line in air 
Assistant RN to use surgical steel clamp and gauze to clamp Silastic tubing as close to the patients head as possible and remove old Medtronic Exacta EVD kit from laser level device 
Assistant to raise line and Operator to place sterile towel under line 
Operator RN to clean the connection between Medtronic Exacta EVD set and silastic tubing with Chlorhexidine 0.5% in Alcohol 70% solution and allow antiseptic solution time to dry completely (this can take up to 2 minutes) 
Disconnect old line (discard in clinical waste at end of procedure) 
Scrub exposed end of silastic catheter using Chlorhexidine soaked gauze for 30 seconds, allow to air dry 
Connect new Medtronic Exacta EVD kit to the patient 
Ensure connection is secure 
Apply new Integra Stopcock protection boxes to both sections of the Medtronic Exacta EVD kit 
Fill both Stopcock boxes with Betadine (iodine 1%) solution and close both boxes
Ensure line is open to the patient (draining to the burette) 
Load new Medtronic Exacta EVD kit into laser level device at appropriate H20 level/height as per Neurosurgeon’s instructions
Remove surgical steel clamp from silastic tubing at patient’s head 
Ensure Medtronic Exacta EVD kit is levelled to the patient’s FOM 
Turn on EVD and ensure it is oscillating or draining 
Remove gloves and perform Hand Hygiene 
Clean trolley, dispose of waste and perform Hand Hygiene
Document in EMR