Elements of the external ventricular drain (EVD) infection control protocol for EVD placement.

  • A wide area of the patient’s hair (A) is clipped to an area large enough to eventually dress with a medium-sized transparent dressing film.
  • Chlorhexidine-alcohol is then applied in a first skin preparation (A, left).
  • Full patient draping is followed by a second chlorhexidine-alcohol skin preparation with the surgeon wearing gown, gloves, cap, and mask (A, center), and full barrier precautions are used throughout (A, right).
  • A minocycline/rifampin antibiotic-impregnated EVD catheter is tunneled 3 to 5 cm and then secured with a curvilinear line of surgical staples (B).
  • After Benzoin tincture is applied to the skin broadly and allowed to fully dry, a chlorhexidine-eluting patch is applied over the exit site (without wrapping the patch around the catheter), and a medium-sized transparent dressing film is applied (B).
  • The borders of the transparent dressing film and the catheter are further secured with adhesive strips (B).
  • Additional information on placement and dressing available at: http://www.cleanbrain.org

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Elements of the external ventricular drain (EVD) infection control protocol for EVD manipulation (cerebrospinal fluid draws or flushing). Supplies are arranged outside the sterile field (A): 70% isopropyl alcohol, a kidney basin, and several 10- mL vials of sterile, preservative-free normal saline. Supplies are then opened onto a sterile field created with a large sterile drape over the patient (B): several chlorhexidine-alcohol swabs, several sterile 10-mL syringes, a surgical sponge, and sterile Luer-fitting port caps. Before gowning and gloving, the 3-way stopcock on the EVD port is turned to 45 (“off” to all directions) and submerged in 70% isopropyl alcohol solution (C). (This step is not performed on the sterile field.) The intensive care unit (ICU) nurse holds the EVD line over the sterile field without allowing the tubing to contact the field (D), and the physician dons cap, mask, sterile gown, and sterile gloves. The physician then cleanses the entire region of the port with a chlorhexidine-alcohol swab. The old port cap is discarded; the port is inverted; and fluid in the port is shaken out onto a surgical sponge (E). The port is cleaned again and then filled with chlorhexidine-alcohol solution (F). The port is inverted, and chlorhexidine-alcohol solution is shaken out onto the surgical sponge (G). Steps F and G are repeated several times. The physician uses the sterile 10-mL syringes to draw up sterile, preservative-free normal saline in sterile fashion from the ICU nurse. The port is rinsed with sterile, preservative-free normal saline, and the port is inverted to discard (H). The rinse step is repeated several times. A sterile 10-mL syringe is then attached to the port for CSF draw or flushing (I). Additional information about EVD manipulation techniques available at: http://www.cleanbrain.org.

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External Ventricular Drain Infection Control Protocol

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References

Flint, Alexander C. et al. “A Simple Protocol To Prevent External Ventricular Drain Infections”.Neurosurgery 72.6 (2013): 993-999. Web.

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