Extraventricular drain
Encyclopedia
An external ventricular drain (EVD), also known as a ventriculostomy, is a device used in neurosurgery
Neurosurgery
Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spine, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.-In the United States:In...

 that relieves raised intracranial pressure
Intracranial pressure
Intracranial pressure is the pressure inside the skull and thus in the brain tissue and cerebrospinal fluid . The body has various mechanisms by which it keeps the ICP stable, with CSF pressures varying by about 1 mmHg in normal adults through shifts in production and absorption of CSF...

 and hydrocephalus
Hydrocephalus
Hydrocephalus , also known as "water in the brain," is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid in the ventricles, or cavities, of the brain. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head,...

 when the normal flow of cerebrospinal fluid
Cerebrospinal fluid
Cerebrospinal fluid , Liquor cerebrospinalis, is a clear, colorless, bodily fluid, that occupies the subarachnoid space and the ventricular system around and inside the brain and spinal cord...

 around the brain
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...

 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
Intracranial pressure
Intracranial pressure is the pressure inside the skull and thus in the brain tissue and cerebrospinal fluid . The body has various mechanisms by which it keeps the ICP stable, with CSF pressures varying by about 1 mmHg in normal adults through shifts in production and absorption of CSF...

.

The tube is most frequently placed in Kocher's point
Kocher's point
Kocher's point is a common entry point for an intraventricular catheter to drain cerebral spinal fluid from the cerebral ventricles. It is located 2.5 centimeters from the midline approximately 11 cm posterior to the nasion. It is important to be at least 1 cm anterior to the coronal...

with the goal of having the catheter tip in the frontal horn of a lateral ventricle. The catheter is normally inserted on the right side of the brain. An EVD (also called an intraventricular catheter, or IVC) is used to monitor pressure in patients with brain injuries, intracranial bleeds or other brain abnormalities that lead to increased fluid build-up. In draining the ventricle it can also remove blood from the ventricular spaces. This is important because blood is an irritant to brain tissue and can cause complications such as vasospasm.

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. Pressure settings are generally measured in cmH2O. The equilibrium pressure of the EVD apparatus is adjusted based on cerebrospinal fluid output, ICP waveform, imaging including CT or MRI of the brain, and clinical response.
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