External Ventricular Drain (EVD) from Joey, LEUNG CHO YEE (TMH-08-065)

Introduction

Source from About.com, a part of The New York Times Company. (2010) retrieved from
http://biology.about.com/library/organs/brain/blventricles.htm

There are four ventricles in the brain that contain specialized cells that produce cerebral
spinal fluid (CSF). CSF is a fluid that contains nutrients that feed and cushion the brain and
spinal cord. Most CSF is produced in the ventricles and reabsorbed into the blood stream.
Normally, CSF is produced and reabsorbed at the same rate. (The Department of
Neurosciences with assistance from the Department of Patient/Family Education, 2003)

Some infections or injuries involving the brain can cause too much CSF to be produced
or not enough to be reabsorbed. The extra CSF puts pressure on the brain. This is called
intracranial pressure. To reduce the pressure, the doctor can insert an EVD into the brain to
drain the extra fluid. The part of the brain where the tube is placed is called the ventricle.
(University of Pittsburgh Medical Center, 2006)

The placement of an external ventricular drain (EVD) is a temporary way to drain CSF
from the ventricles and relieve pressure in the skull. It is a flexible tube that is inserted through
the skull and placed in either the right or left lateral ventricle. The tube is attached to a
drainage system outside of the body, which is carefully positioned to control the amount of
CSF drainage. Normally CSF is clear and colorless. (The Department of Neurosciences with

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assistance from the Department of Patient/Family Education, 2003)

Definition
An extraventricular drain (EVD) is a device used in neurosurgery that relieves raised
intracranial pressure and hydrocephalus when the normal flow of cerebrospinal fluid around
the brain is obstructed. These are 10 French tubes placed by neurosurgeons and managed
by ICU nurses to drain fluid from the ventricles of the brain, and thus keep them
decompressed, as well as to monitor intracranial pressure. (Creative Commons Attribution-
ShareAlike License, 2009)

If the EVD becomes occluded, clogged, or obstructed, as it often does with fibrinous or
clot like material, the brain can swell due to pressure build up in the ventricles and permanent
brain damage can occur. Thus nurses and neurosugeons often have to adjust or flush these
small diameter catheters to manage medical tube obstructions and occlusions in the ICU
setting. (Creative Commons Attribution-ShareAlike License, 2009)

How does it work?

The fluid flows from the brain, through the EVD, and into a bag. The bag hangs on the
head of the patient’s bed or on an IV (intravenous) pole. The doctor and nurse check how
much fluid drains into the bag. The EVD has a device that helps measure pressure in the
brain as fluid drains. It lets the doctor and nurse know if the extra pressure is decreasing. The
EVD is used for a period of time and then is removed. (University of Pittsburgh Medical
Center, 2006)

S/S of increasing ICP

• headache
• nausea and vomiting
• becoming less alert or less awake
• sensory and motor deficits
• change in pupil sizes
• change in vital signs( Cushing’s triad)
• abnormal reflexes
• irregular breathing
• papilloedema ( swelling of the optic disc)

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• hyperthermia
• seizures
• herniation syndromes

(Second hand note from Miss Cheung, 2009 and University of Pittsburgh Medical Center,
2006)

Causes for extra brain fluid/ increasing ICP

• a bulge in a blood vessel (aneurysm) that breaks open
• a tumor
• a stroke
• a serious head injury
(University of Pittsburgh Medical Center, 2006)

Care of EVD
1. Dressing
The dressing should remain on at all times. Prevent from picking at the dressing as this
can cause an infection. If the dressing should come loose or fall off, inform and replace it as
necessary.
Do not allow the dressing to get wet. If there is drainage from the site, inform
immediately. Sometimes CSF can leak out from the site and make the pillow feel damp.
(The Department of Neurosciences with assistance from the Department of Patient/Family
Education, 2003)

2. The Drainage Tubing and Collection Chamber:

It is important that the tubing or bag not get caught in the bed rails or get pulled as this
can cause breakage or dislodgement of the drainage tube. This may result in a repeat
operation for reinsertion of the EVD.

There should never be any leakage on the exterior of the bag or tubing. If you notice any
leakage, inform immediately.

Adjust the height of the drainage bag or take the drainage bag out of the blue leveling
device as doctor’s prescription. Wrong adjustment can cause too much or too little CSF to
drain. (The Department of Neurosciences with assistance from the Department of

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Patient/Family Education, 2003)

3. Positioning in Bed:

Patients will be required to stay at a very specific level in bed while the EVD is draining.
This ensures the level of the drainage system remains constant. The nurse will mark the bed
to make it easy to see. If patient slips down in bed, adjust the correct level as doctor’s
prescription. (The Department of Neurosciences with assistance from the Department of
Patient/Family Education, 2003)

4. General Behavior:

Nurse is supposed to assess patient’s neurological status on a regular basis while the
EVD is in place. It is important to report any abnormalities changes in behavior, including
complains of a headache, experiences nausea and vomiting or becomes increasingly more
tired. (The Department of Neurosciences with assistance from the Department of
Patient/Family Education, 2003)

Complications
• bleeding inside the brain or where the tube enters the head
• infection of the brain fluid or of the brain itself
The doctor and nurse are supposed to watch closely for signs of infection. The patient’s
temperature is checked often. Brain fluid samples are tested in the lab frequently.

References
1. About.com, a part of The New York Times Company. ( 2010) retrieved from
http://biology.about.com/library/organs/brain/blventricles.htm

2. Creative Commons Attribution-ShareAlike License (2009) An extraventricular drain

retrieved from http://en.wikipedia.org/wiki/External_ventricular_drain

3. The Department of Neurosciences with assistance from the Department of Patient/Family

Education (2003) External Ventricular Drains (EVD) and Externalized Shunts retrieved from
http://www.cw.bc.ca/library/pamphlets/search_view.asp?keyword=372

4. University of Pittsburgh Medical Center (2006) External Ventricular Drain retrieved from

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http://www.upmc.com/HealthAtoZ/patienteducation/Documents/ExtVentricularDrain.pdf