Show pageBacklinksCite current pageExport to PDFBack to top This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong. ====== 🛠️ External Ventricular Drainage Technique ====== ===== Latest related articles on PubMed ===== {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1HQ7Swgujy3Kdd0JMEA0TC-JKHL0c07xXMZFKag4JXzdcw9sDv/?limit=15&utm_campaign=pubmed-2&fc=20250705030259}} Step-by-step guide to perform **[[ventriculostomy]]** for [[cerebrospinal fluid drainage]] in cases of [[hydrocephalus]], [[intraventricular hemorrhage]], or [[intracranial hypertension]]. ===== 📌 1. Preparation ===== * ☐ Verify **indication** (e.g., IVH, ↑ICP, hydrocephalus) * ☐ Review imaging (CT or MRI) * ☐ Coagulation parameters: INR < 1.5, platelets > 100k/µL * ☐ Consent (if feasible) * ☐ Shave and clean frontal region * ☐ Prepare sterile EVD kit, manometer/collection system ===== 📍 2. Landmark Identification ===== * [[Kocher’s Point]]: - ~11 cm posterior to nasion - 2.5–3 cm lateral to midline - ~1 cm anterior to coronal suture * Side: typically **non-dominant hemisphere** (unless pathology dictates otherwise) ===== 🔧 3. Procedure Steps ===== - Position: **Supine**, head elevated 20–30° - Anesthesia: Local (± sedation) or general if intubated - [[Skin incision]] (1.5–2 cm) at Kocher’s point - Drill burr hole perpendicular to skull - Open [[dura]] carefully with monopolar or blade - Insert catheter **toward contralateral medial canthus**, aiming ~5–6 cm depth - Confirm **CSF (or bloody CSF)** return - Advance slightly (~2–3 mm) once CSF flow confirmed - Tunnel catheter subcutaneously if long-term use - Suture to scalp securely ===== 💧 4. Drainage System Setup ===== * Connect catheter to **closed drainage system** * Level transducer or chamber to **external auditory meatus (EAM)** * Typical initial height: **+10 to +15 cmH₂O** * Secure tubing, avoid dependent loops ===== 🔍 5. Post-Insertion Care ===== * Check **CT scan** for catheter position and complications * Monitor: - Drainage volume - ICP waveform and trends - Neurologic status * Label system with date/time of insertion * Keep connections closed; sample only if clinically indicated * Daily assessment of need for continued drainage ===== ⚠️ 6. Troubleshooting ===== | Issue | Action | |-------|--------| | No CSF return | Slight repositioning, flush with saline (if protocolized) | | Obstruction | Confirm level, irrigate gently | | Overdrainage | Raise system height, check for leak | | Infection signs | Culture CSF, consider antibiotic EVD or replacement | external_ventricular_drainage_technique.txt Last modified: 2025/07/05 07:07by administrador