====== 🛠️ External Ventricular Drainage Technique ======

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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 |