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1. Shard Calculation

Query:

Response:

Calculated Shard: 152 (from laksa175)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa152.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://en.wikipedia.org/wiki/External_ventricular_drain\')), getAhrefsUnparsedNoserviceFromURL(\'https://en.wikipedia.org/wiki/External_ventricular_drain\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain","crawl_time":1754607060,"first_indexed_time":0,"http_code":200,"src_unparsed":"org,wikipedia!en,\/wiki\/External_ventricular_drain s443","src_root_hash":"17790707453426894952","history_drop_reason":null,"meta_title":"External ventricular drain - Wikipedia","meta_descriptions":[],"attrs_boilerpipe_text":"An  external ventricular drain  ( EVD ), [ 1 ]  also known as a  ventriculostomy  or  extraventricular drain , is a device used in  neurosurgery  to treat  hydrocephalus  and relieve elevated  intracranial pressure  when the normal flow of  cerebrospinal fluid  (CSF) inside the  brain  is obstructed. An EVD is a flexible plastic catheter placed by a  neurosurgeon  or  neurointensivist  and managed by  intensive care unit  (ICU) physicians and nurses. The purpose of external ventricular drainage is to divert fluid from the ventricles of the brain and allow for monitoring of  intracranial pressure . An EVD must be placed in a center with full neurosurgical capabilities, because immediate neurosurgical intervention can be needed if a complication of EVD placement, such as bleeding, is encountered.\n EVDs are a short-term solution to hydrocephalus, and if the underlying hydrocephalus does not eventually resolve, it may be necessary to convert the EVD to a  cerebral shunt , which is a fully internalized, long-term treatment for hydrocephalus. [ 2 ] The EVD catheter is most frequently placed by way of a twist-drill craniostomy placed at  Kocher's point , a location in the  frontal bone  of the skull, with the goal of placing the catheter tip in the frontal horn of the  lateral ventricle  or in the  third ventricle . [ 3 ] [ 4 ]  The catheter is typically inserted on the right side of the brain, but in some cases a left-sided approach is used, and in other situations catheters are needed on both sides. [ 4 ]  EVDs can be used to monitor intracranial pressure in patients with  traumatic brain injury  (TBI), [ 5 ] subarachnoid hemorrhage  (SAH), [ 6 ] intracerebral hemorrhage  (ICH), or other brain abnormalities that lead to increased CSF build-up. In draining the ventricle, the EVD can also remove blood products from the ventricular spaces. This is important because blood is an irritant to brain tissue and can cause complications such as  vasospasm .\n The EVD is leveled to a common reference point that corresponds to the skull base, usually the  tragus  or  external auditory meatus . The EVD is set to drain into a closed, graduated burette at a height corresponding to a particular pressure level, as prescribed by a healthcare professional, usually a  neurosurgeon  or  neurointensivist . Leveling the EVD to a set pressure level is the basis for  cerebrospinal fluid  (CSF) drainage;  hydrostatic pressure  dictates CSF drainage. The fluid column pressure must be greater than the weight of the CSF in the system before drainage occurs. It is therefore important that family members and visitors understand the patient's head of bed position cannot be changed without assistance. [ 7 ] An example of a healthcare provider order regarding an EVD is: set EVD to drain CSF for ICP > 15 mm Hg, check and record cerebrospinal fluid drainage and  intracranial pressure  at least hourly. Continuous CSF drainage is associated with a higher risk of complications. [ 8 ]  The  cerebral perfusion pressure  (CPP) can be calculated from data obtained from the EVD and systemic blood pressure. In order to calculate the CPP the  intracranial pressure  and  mean arterial pressure  (MAP) must be available. [ 7 ] C P P = M A P − I C P {\\displaystyle CPP=MAP-ICP} Other areas that should be monitored are: signs and symptoms of intracranial hypertension, looking for any leaks in the EVD system to prevent infection from entering the brain, and changes in the amount and color of the CSF. A sudden increase in hourly output of CSF may indicate intracranial hypertension, bloody CSF may indicate recurrent aneurysm rupture, and cloudy CSF may indicate brain infection. [ 9 ] EVD placement is an invasive procedure. It is associated with several potential complications:\n Bleeding can occur along the EVD insertion tract or in the several layers of the meninges that prohibit passage into the brain. If drilling or dural puncture is not successful, the surgeon may dissect away dura and create a secondary bleed known as an epidural or subdural hemorrhage. Bleeding from EVD placement can be life-threatening and can require neurosurgical intervention in some cases. The risk of hemorrhage with EVD placement is increased if the patient suffers from  coagulopathy .\n Mechanical complications from EVD placement can be categorized into:\n Malplacement of the EVD tube into the brain tissue instead of ventricles can occur in 10 to 40% of the cases. Therefore, computed tomography (CT), ultrasound, endoscopy, and stereotactic neuronavigation are used to minimize placement errors of EVD tubes. [ 9 ] Obstruction\/occlusion of EVD commonly due to fibrinous\/clot like material or kinking of the tube. The brain can swell due to pressure build up in the ventricles and permanent brain damage can occur. Physicians or nurses may have to adjust or flush these small diameter catheters to manage medical tube obstructions and occlusions at the intensive-care bedside. [ 10 ] After EVD placement, the drain is tunneled subcutaneously and secured with  surgical sutures  and\/or  surgical staples . However, it is possible for the EVD to dislodge or migrate. This will cause the tip of the drain to migrate away from its intended position and provide inaccurate ICP measurement or lead to occlusion of the drain.\n The EVD is a foreign body inserted into the brain, and as such it represents a potential portal for serious infection. Historically, the rate of infections associated with EVDs has been very high, ranging from 5% to > 20%. [ 11 ] [ 12 ]  Infections associated with EVDs can progress to become a severe form of brain infection known as  ventriculitis . Protocols designed to reduce the rate of EVD infections have been successful, applying  infection control  'bundle' approaches to reduce the rate of infection to well less than 1%. [ 13 ] [ 14 ] [ 15 ] Although neurological deficits from passing the EVD catheter across the brain are uncommon, there can be an association of a patient's poor neurological status with EVD malplacement. [ 16 ]  In one report, the EVD was inserted too deeply into the fourth ventricle; the authors hypothesized that the patient's coma was due to irritation of the  recticular activating system . The patient's level of consciousness improved after the EVD was adjusted. [ 16 ]","attrs_markdown":"[Jump to content](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#bodyContent)\n\nMain menu\n\nMain menu\n\nmove to sidebar\n\nhide\n\nNavigation\n\n- [Main page](https:\/\/en.wikipedia.org\/wiki\/Main_Page \"Visit the main page [z]\")\n- [Contents](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Contents \"Guides to browsing Wikipedia\")\n- [Current events](https:\/\/en.wikipedia.org\/wiki\/Portal:Current_events \"Articles related to current events\")\n- [Random article](https:\/\/en.wikipedia.org\/wiki\/Special:Random \"Visit a randomly selected article [x]\")\n- [About Wikipedia](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:About \"Learn about Wikipedia and how it works\")\n- [Contact us](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Contact_us \"How to contact Wikipedia\")\n\nContribute\n\n- [Help](https:\/\/en.wikipedia.org\/wiki\/Help:Contents \"Guidance on how to use and edit Wikipedia\")\n- [Learn to edit](https:\/\/en.wikipedia.org\/wiki\/Help:Introduction \"Learn how to edit Wikipedia\")\n- [Community portal](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Community_portal \"The hub for editors\")\n- [Recent changes](https:\/\/en.wikipedia.org\/wiki\/Special:RecentChanges \"A list of recent changes to Wikipedia [r]\")\n- [Upload file](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:File_upload_wizard \"Add images or other media for use on Wikipedia\")\n- [Special pages](https:\/\/en.wikipedia.org\/wiki\/Special:SpecialPages)\n\n[![](https:\/\/en.wikipedia.org\/static\/images\/icons\/wikipedia.png) ![Wikipedia](https:\/\/en.wikipedia.org\/static\/images\/mobile\/copyright\/wikipedia-wordmark-en.svg) ![The Free Encyclopedia](https:\/\/en.wikipedia.org\/static\/images\/mobile\/copyright\/wikipedia-tagline-en.svg)](https:\/\/en.wikipedia.org\/wiki\/Main_Page)\n\n[Search](https:\/\/en.wikipedia.org\/wiki\/Special:Search \"Search Wikipedia [f]\")\n\nAppearance\n\n- [Donate](https:\/\/donate.wikimedia.org\/?wmf_source=donate&wmf_medium=sidebar&wmf_campaign=en.wikipedia.org&uselang=en)\n- [Create account](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:CreateAccount&returnto=External+ventricular+drain \"You are encouraged to create an account and log in; however, it is not mandatory\")\n- [Log in](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:UserLogin&returnto=External+ventricular+drain \"You're encouraged to log in; however, it's not mandatory. [o]\")\n\nPersonal tools\n\n- [Donate](https:\/\/donate.wikimedia.org\/?wmf_source=donate&wmf_medium=sidebar&wmf_campaign=en.wikipedia.org&uselang=en)\n- [Create account](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:CreateAccount&returnto=External+ventricular+drain \"You are encouraged to create an account and log in; however, it is not mandatory\")\n- [Log in](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:UserLogin&returnto=External+ventricular+drain \"You're encouraged to log in; however, it's not mandatory. [o]\")\n\nPages for logged out editors [learn more](https:\/\/en.wikipedia.org\/wiki\/Help:Introduction)\n\n- [Contributions](https:\/\/en.wikipedia.org\/wiki\/Special:MyContributions \"A list of edits made from this IP address [y]\")\n- [Talk](https:\/\/en.wikipedia.org\/wiki\/Special:MyTalk \"Discussion about edits from this IP address [n]\")\n\n## Contents\nmove to sidebar\n\nhide\n\n- [(Top)](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain)\n- [1 EVD placement](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#EVD_placement)\n- [2 Ongoing care](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#Ongoing_care)\n- [3 Complications](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#Complications)\n  Toggle Complications subsection\n  - [3\\.1 Bleeding](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#Bleeding)\n  - [3\\.2 Mechanical](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#Mechanical)\n  - [3\\.3 Infection](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#Infection)\n  - [3\\.4 Neurological](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#Neurological)\n- [4 References](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#References)\n\nToggle the table of contents\n\n# External ventricular drain\n8 languages\n\n- [العربية](https:\/\/ar.wikipedia.org\/wiki\/%D9%85%D9%86%D8%B2%D8%AD_%D8%A8%D8%B7%D9%8A%D9%86%D9%8A_%D8%AE%D8%A7%D8%B1%D8%AC%D9%8A \"منزح بطيني خارجي – Arabic\")\n- [Deutsch](https:\/\/de.wikipedia.org\/wiki\/Externe_Ventrikeldrainage \"Externe Ventrikeldrainage – German\")\n- [Nederlands](https:\/\/nl.wikipedia.org\/wiki\/Ventrikeldrain \"Ventrikeldrain – Dutch\")\n- [Polski](https:\/\/pl.wikipedia.org\/wiki\/Zewn%C4%99trzny_dren_komorowy \"Zewnętrzny dren komorowy – Polish\")\n- [Português](https:\/\/pt.wikipedia.org\/wiki\/Deriva%C3%A7%C3%A3o_ventricular_externa \"Derivação ventricular externa – Portuguese\")\n- [Српски \/ srpski](https:\/\/sr.wikipedia.org\/wiki\/%D0%A1%D0%BF%D0%BE%D1%99%D0%BD%D0%B8_%D0%B2%D0%B5%D0%BD%D1%82%D1%80%D0%B8%D0%BA%D1%83%D0%BB%D0%B0%D1%80%D0%BD%D0%B8_%D0%B4%D1%80%D0%B5%D0%BD \"Спољни вентрикуларни дрен – Serbian\")\n- [Türkçe](https:\/\/tr.wikipedia.org\/wiki\/Eksternal_ventrik%C3%BCler_drenaj \"Eksternal ventriküler drenaj – Turkish\")\n- [中文](https:\/\/zh.wikipedia.org\/wiki\/%E8%85%A6%E5%AE%A4%E5%A4%96%E5%BC%95%E6%B5%81 \"腦室外引流 – Chinese\")\n\n[Edit links](https:\/\/www.wikidata.org\/wiki\/Special:EntityPage\/Q5422058#sitelinks-wikipedia \"Edit interlanguage links\")\n\n- [Article](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain \"View the content page [c]\")\n- [Talk](https:\/\/en.wikipedia.org\/wiki\/Talk:External_ventricular_drain \"Discuss improvements to the content page [t]\")\n\nEnglish\n\n- [Read](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain)\n- [Edit](https:\/\/en.wikipedia.org\/w\/index.php?title=External_ventricular_drain&action=edit \"Edit this page [e]\")\n- [View history](https:\/\/en.wikipedia.org\/w\/index.php?title=External_ventricular_drain&action=history \"Past revisions of this page [h]\")\n\nTools\n\nTools\n\nmove to sidebar\n\nhide\n\nActions\n\n- [Read](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain)\n- [Edit](https:\/\/en.wikipedia.org\/w\/index.php?title=External_ventricular_drain&action=edit \"Edit this page [e]\")\n- [View history](https:\/\/en.wikipedia.org\/w\/index.php?title=External_ventricular_drain&action=history)\n\nGeneral\n\n- [What links here](https:\/\/en.wikipedia.org\/wiki\/Special:WhatLinksHere\/External_ventricular_drain \"List of all English Wikipedia pages containing links to this page [j]\")\n- [Related changes](https:\/\/en.wikipedia.org\/wiki\/Special:RecentChangesLinked\/External_ventricular_drain \"Recent changes in pages linked from this page [k]\")\n- [Upload file](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:File_Upload_Wizard \"Upload files [u]\")\n- [Permanent link](https:\/\/en.wikipedia.org\/w\/index.php?title=External_ventricular_drain&oldid=1297737845 \"Permanent link to this revision of this page\")\n- [Page information](https:\/\/en.wikipedia.org\/w\/index.php?title=External_ventricular_drain&action=info \"More information about this page\")\n- [Cite this page](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:CiteThisPage&page=External_ventricular_drain&id=1297737845&wpFormIdentifier=titleform \"Information on how to cite this page\")\n- [Get shortened URL](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:UrlShortener&url=https%3A%2F%2Fen.wikipedia.org%2Fwiki%2FExternal_ventricular_drain)\n- [Download QR code](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:QrCode&url=https%3A%2F%2Fen.wikipedia.org%2Fwiki%2FExternal_ventricular_drain)\n\nPrint\/export\n\n- [Download as PDF](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:DownloadAsPdf&page=External_ventricular_drain&action=show-download-screen \"Download this page as a PDF file\")\n- [Printable version](https:\/\/en.wikipedia.org\/w\/index.php?title=External_ventricular_drain&printable=yes \"Printable version of this page [p]\")\n\nIn other projects\n\n- [Wikimedia Commons](https:\/\/commons.wikimedia.org\/wiki\/Category:Cerebral_shunt)\n- [Wikidata item](https:\/\/www.wikidata.org\/wiki\/Special:EntityPage\/Q5422058 \"Structured data on this page hosted by Wikidata [g]\")\n\nAppearance\n\nmove to sidebar\n\nhide\n\nFrom Wikipedia, the free encyclopedia\n\nMedical device\n\n|   |   |\n|---|---|\n| [![](https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/60px-Question_book-new.svg.png)](https:\/\/en.wikipedia.org\/wiki\/File:Question_book-new.svg) | This article **needs additional citations for [verification](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Verifiability \"Wikipedia:Verifiability\")**. Please help [improve this article](https:\/\/en.wikipedia.org\/wiki\/Special:EditPage\/External_ventricular_drain \"Special:EditPage\/External ventricular drain\") by [adding citations to reliable sources](https:\/\/en.wikipedia.org\/wiki\/Help:Referencing_for_beginners \"Help:Referencing for beginners\"). Unsourced material may be challenged and removed. *Find sources:* [\"External ventricular drain\"](https:\/\/www.google.com\/search?as_eq=wikipedia&q=%22External+ventricular+drain%22) – [news](https:\/\/www.google.com\/search?tbm=nws&q=%22External+ventricular+drain%22+-wikipedia&tbs=ar:1) **·** [newspapers](https:\/\/www.google.com\/search?&q=%22External+ventricular+drain%22&tbs=bkt:s&tbm=bks) **·** [books](https:\/\/www.google.com\/search?tbs=bks:1&q=%22External+ventricular+drain%22+-wikipedia) **·** [scholar](https:\/\/scholar.google.com\/scholar?q=%22External+ventricular+drain%22) **·** [JSTOR](https:\/\/www.jstor.org\/action\/doBasicSearch?Query=%22External+ventricular+drain%22&acc=on&wc=on) *(October 2017)* *([Learn how and when to remove this message](https:\/\/en.wikipedia.org\/wiki\/Help:Maintenance_template_removal \"Help:Maintenance template removal\"))* |\n\nMedical intervention\n\n| **External ventricular drain** |\n|---|\n| [![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/de\/EVD-ICH.jpg\/250px-EVD-ICH.jpg)](https:\/\/en.wikipedia.org\/wiki\/File:EVD-ICH.jpg)Drainage system showing bloody CSF due to intracranial hemorrhage |\n| \\[[edit on Wikidata](https:\/\/www.wikidata.org\/wiki\/Q5422058 \"d:Q5422058\")\\] |\n\nAn **external ventricular drain** (**EVD**),[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-1) also known as a **[ventriculostomy](https:\/\/en.wikipedia.org\/wiki\/Ventriculostomy \"Ventriculostomy\")** or **extraventricular drain**, is a device used in [neurosurgery](https:\/\/en.wikipedia.org\/wiki\/Neurosurgery \"Neurosurgery\") to treat [hydrocephalus](https:\/\/en.wikipedia.org\/wiki\/Hydrocephalus \"Hydrocephalus\") and relieve elevated [intracranial pressure](https:\/\/en.wikipedia.org\/wiki\/Intracranial_pressure \"Intracranial pressure\") when the normal flow of [cerebrospinal fluid](https:\/\/en.wikipedia.org\/wiki\/Cerebrospinal_fluid \"Cerebrospinal fluid\") (CSF) inside the [brain](https:\/\/en.wikipedia.org\/wiki\/Brain \"Brain\") is obstructed. An EVD is a flexible plastic catheter placed by a [neurosurgeon](https:\/\/en.wikipedia.org\/wiki\/Neurosurgery \"Neurosurgery\") or [neurointensivist](https:\/\/en.wikipedia.org\/wiki\/Neurointensive_care \"Neurointensive care\") and managed by [intensive care unit](https:\/\/en.wikipedia.org\/wiki\/Intensive_care_unit \"Intensive care unit\") (ICU) physicians and nurses. The purpose of external ventricular drainage is to divert fluid from the ventricles of the brain and allow for monitoring of [intracranial pressure](https:\/\/en.wikipedia.org\/wiki\/Intracranial_pressure \"Intracranial pressure\"). An EVD must be placed in a center with full neurosurgical capabilities, because immediate neurosurgical intervention can be needed if a complication of EVD placement, such as bleeding, is encountered.\n\nEVDs are a short-term solution to hydrocephalus, and if the underlying hydrocephalus does not eventually resolve, it may be necessary to convert the EVD to a [cerebral shunt](https:\/\/en.wikipedia.org\/wiki\/Cerebral_shunt \"Cerebral shunt\"), which is a fully internalized, long-term treatment for hydrocephalus.[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-pmid_19035711-2)\n\n## EVD placement\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=External_ventricular_drain&action=edit&section=1 \"Edit section: EVD placement\")\\]\n\nThe EVD catheter is most frequently placed by way of a twist-drill craniostomy placed at [Kocher's point](https:\/\/en.wikipedia.org\/wiki\/Kocher%27s_point \"Kocher's point\"), a location in the [frontal bone](https:\/\/en.wikipedia.org\/wiki\/Frontal_bone \"Frontal bone\") of the skull, with the goal of placing the catheter tip in the frontal horn of the [lateral ventricle](https:\/\/en.wikipedia.org\/wiki\/Lateral_ventricle \"Lateral ventricle\") or in the [third ventricle](https:\/\/en.wikipedia.org\/wiki\/Third_ventricle \"Third ventricle\").[\\[3\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-KumarLevine2017-3)[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-Proctor2007-4) The catheter is typically inserted on the right side of the brain, but in some cases a left-sided approach is used, and in other situations catheters are needed on both sides.[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-Proctor2007-4) EVDs can be used to monitor intracranial pressure in patients with [traumatic brain injury](https:\/\/en.wikipedia.org\/wiki\/Traumatic_brain_injury \"Traumatic brain injury\") (TBI),[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-Sundstr%C3%B8mGr%C3%A4nde2012-5) [subarachnoid hemorrhage](https:\/\/en.wikipedia.org\/wiki\/Subarachnoid_hemorrhage \"Subarachnoid hemorrhage\") (SAH),[\\[6\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-O'DonnellN%C3%A1cul2016-6) [intracerebral hemorrhage](https:\/\/en.wikipedia.org\/wiki\/Intracerebral_hemorrhage \"Intracerebral hemorrhage\") (ICH), or other brain abnormalities that lead to increased CSF build-up. In draining the ventricle, the EVD can also remove blood products from the ventricular spaces. This is important because blood is an irritant to brain tissue and can cause complications such as [vasospasm](https:\/\/en.wikipedia.org\/wiki\/Vasospasm \"Vasospasm\").\n\n## Ongoing care\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=External_ventricular_drain&action=edit&section=2 \"Edit section: Ongoing care\")\\]\n\nThe EVD is leveled to a common reference point that corresponds to the skull base, usually the [tragus](https:\/\/en.wikipedia.org\/wiki\/Tragus_\\(ear\\) \"Tragus (ear)\") or [external auditory meatus](https:\/\/en.wikipedia.org\/wiki\/Ear_canal \"Ear canal\"). The EVD is set to drain into a closed, graduated burette at a height corresponding to a particular pressure level, as prescribed by a healthcare professional, usually a [neurosurgeon](https:\/\/en.wikipedia.org\/wiki\/Neurosurgery \"Neurosurgery\") or [neurointensivist](https:\/\/en.wikipedia.org\/wiki\/Neurointensive_care \"Neurointensive care\"). Leveling the EVD to a set pressure level is the basis for [cerebrospinal fluid](https:\/\/en.wikipedia.org\/wiki\/Cerebrospinal_fluid \"Cerebrospinal fluid\") (CSF) drainage; [hydrostatic pressure](https:\/\/en.wikipedia.org\/wiki\/Hydrostatic_pressure \"Hydrostatic pressure\") dictates CSF drainage. The fluid column pressure must be greater than the weight of the CSF in the system before drainage occurs. It is therefore important that family members and visitors understand the patient's head of bed position cannot be changed without assistance.[\\[7\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-aann.org-7)\n\nAn example of a healthcare provider order regarding an EVD is: set EVD to drain CSF for ICP \\> 15 mm Hg, check and record cerebrospinal fluid drainage and [intracranial pressure](https:\/\/en.wikipedia.org\/wiki\/Intracranial_pressure \"Intracranial pressure\") at least hourly. Continuous CSF drainage is associated with a higher risk of complications.[\\[8\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-8) The [cerebral perfusion pressure](https:\/\/en.wikipedia.org\/wiki\/Cerebral_perfusion_pressure \"Cerebral perfusion pressure\") (CPP) can be calculated from data obtained from the EVD and systemic blood pressure. In order to calculate the CPP the [intracranial pressure](https:\/\/en.wikipedia.org\/wiki\/Intracranial_pressure \"Intracranial pressure\") and [mean arterial pressure](https:\/\/en.wikipedia.org\/wiki\/Mean_arterial_pressure \"Mean arterial pressure\") (MAP) must be available.[\\[7\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-aann.org-7)\n\nC P P \\= M A P − I C P {\\\\displaystyle CPP=MAP-ICP} ![{\\\\displaystyle CPP=MAP-ICP}](https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/ba9e025c26bccc1626e8f75ee7c9458caa1a3021)\n\nOther areas that should be monitored are: signs and symptoms of intracranial hypertension, looking for any leaks in the EVD system to prevent infection from entering the brain, and changes in the amount and color of the CSF. A sudden increase in hourly output of CSF may indicate intracranial hypertension, bloody CSF may indicate recurrent aneurysm rupture, and cloudy CSF may indicate brain infection.[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-pmid26069848-9)\n\n## Complications\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=External_ventricular_drain&action=edit&section=3 \"Edit section: Complications\")\\]\n\nEVD placement is an invasive procedure. It is associated with several potential complications:\n\n### Bleeding\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=External_ventricular_drain&action=edit&section=4 \"Edit section: Bleeding\")\\]\n\nBleeding can occur along the EVD insertion tract or in the several layers of the meninges that prohibit passage into the brain. If drilling or dural puncture is not successful, the surgeon may dissect away dura and create a secondary bleed known as an epidural or subdural hemorrhage. Bleeding from EVD placement can be life-threatening and can require neurosurgical intervention in some cases. The risk of hemorrhage with EVD placement is increased if the patient suffers from [coagulopathy](https:\/\/en.wikipedia.org\/wiki\/Coagulopathy \"Coagulopathy\").\n\n### Mechanical\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=External_ventricular_drain&action=edit&section=5 \"Edit section: Mechanical\")\\]\n\nMechanical complications from EVD placement can be categorized into:\n\n- Malplacement\n\nMalplacement of the EVD tube into the brain tissue instead of ventricles can occur in 10 to 40% of the cases. Therefore, computed tomography (CT), ultrasound, endoscopy, and stereotactic neuronavigation are used to minimize placement errors of EVD tubes.[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-pmid26069848-9)\n\n- Obstruction\n\nObstruction\/occlusion of EVD commonly due to fibrinous\/clot like material or kinking of the tube. The brain can swell due to pressure build up in the ventricles and permanent brain damage can occur. Physicians or nurses may have to adjust or flush these small diameter catheters to manage medical tube obstructions and occlusions at the intensive-care bedside.[\\[10\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-pmid18728595-10)\n\n- Migration\n\nAfter EVD placement, the drain is tunneled subcutaneously and secured with [surgical sutures](https:\/\/en.wikipedia.org\/wiki\/Surgical_suture \"Surgical suture\") and\/or [surgical staples](https:\/\/en.wikipedia.org\/wiki\/Surgical_staple \"Surgical staple\"). However, it is possible for the EVD to dislodge or migrate. This will cause the tip of the drain to migrate away from its intended position and provide inaccurate ICP measurement or lead to occlusion of the drain.\n\n### Infection\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=External_ventricular_drain&action=edit&section=6 \"Edit section: Infection\")\\]\n\nThe EVD is a foreign body inserted into the brain, and as such it represents a potential portal for serious infection. Historically, the rate of infections associated with EVDs has been very high, ranging from 5% to \\> 20%.[\\[11\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-11)[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-12) Infections associated with EVDs can progress to become a severe form of brain infection known as [ventriculitis](https:\/\/en.wikipedia.org\/wiki\/Ventriculitis \"Ventriculitis\"). Protocols designed to reduce the rate of EVD infections have been successful, applying [infection control](https:\/\/en.wikipedia.org\/wiki\/Infection_control \"Infection control\") 'bundle' approaches to reduce the rate of infection to well less than 1%.[\\[13\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-13)[\\[14\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-14)[\\[15\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-15)\n\n### Neurological\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=External_ventricular_drain&action=edit&section=7 \"Edit section: Neurological\")\\]\n\nAlthough neurological deficits from passing the EVD catheter across the brain are uncommon, there can be an association of a patient's poor neurological status with EVD malplacement.[\\[16\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-pmid24101284-16) In one report, the EVD was inserted too deeply into the fourth ventricle; the authors hypothesized that the patient's coma was due to irritation of the [recticular activating system](https:\/\/en.wikipedia.org\/wiki\/Reticular_activating_system \"Reticular activating system\"). The patient's level of consciousness improved after the EVD was adjusted.[\\[16\\]](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_note-pmid24101284-16)\n\n## References\n\\[[edit](https:\/\/en.wikipedia.org\/w\/index.php?title=External_ventricular_drain&action=edit&section=8 \"Edit section: References\")\\]\n\n1. **[^](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-1)**\n   Logan CM, Rice MK (1987). *Logan's Medical and Scientific Abbreviations* (Hardbound book). [J. B. Lippincott](https:\/\/en.wikipedia.org\/wiki\/J._B._Lippincott_%26_Co. \"J. B. Lippincott & Co.\"). p. 183. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [0-397-54589-4](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/0-397-54589-4 \"Special:BookSources\/0-397-54589-4\")\n   \n   .\n2. **[^](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-pmid_19035711_2-0)**\n   Rammos, S; et al. (2008), \"Conversion of external ventricular drains to ventriculoperitoneal shunts after aneurysmal subarachnoid hemorrhage: effects of site and protein\/red blood cell counts on shunt infection and malfunction\", *J Neurosurg*, **109** (6): 1001–1004, [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.3171\/JNS.2008.109.12.1001](https:\/\/doi.org\/10.3171%2FJNS.2008.109.12.1001), [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [19035711](https:\/\/pubmed.ncbi.nlm.nih.gov\/19035711), [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [34114285](https:\/\/api.semanticscholar.org\/CorpusID:34114285).\n3. **[^](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-KumarLevine2017_3-0)**\n   Monisha Kumar; Joshua Levine; James Schuster; W. Andrew Kofke (20 January 2017). [*Neurocritical Care Management of the Neurosurgical Patient E-Book*](https:\/\/books.google.com\/books?id=6a74DQAAQBAJ&pg=PA265). Elsevier Health Sciences. pp. 265–. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-0-323-32222-5](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-0-323-32222-5 \"Special:BookSources\/978-0-323-32222-5\")\n   \n   .\n4. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-Proctor2007_4-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-Proctor2007_4-1)\n   Mark R. Proctor (23 November 2007). [*Minimally Invasive Neurosurgery*](https:\/\/books.google.com\/books?id=kz54UMcjHSsC&pg=PA402). Springer Science & Business Media. pp. 402–. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-1-59259-899-1](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-1-59259-899-1 \"Special:BookSources\/978-1-59259-899-1\")\n   \n   .\n5. **[^](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-Sundstr%C3%B8mGr%C3%A4nde2012_5-0)**\n   Terje Sundstrøm; Per-Olof Grände; Niels Juul; Carsten Kock-Jensen, Bertil Romner and Knut Wester (25 June 2012). [*Management of Severe Traumatic Brain Injury: Evidence, Tricks, and Pitfalls*](https:\/\/books.google.com\/books?id=73UnMpOkf24C&pg=PA120). Springer Science & Business Media. pp. 120–. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-3-642-28126-6](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-3-642-28126-6 \"Special:BookSources\/978-3-642-28126-6\")\n   \n   .\n6. **[^](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-O'DonnellN%C3%A1cul2016_6-0)**\n   John M. O'Donnell; Flávio E. Nácul (12 July 2016). [*Surgical Intensive Care Medicine*](https:\/\/books.google.com\/books?id=sbGqDAAAQBAJ&pg=PA226). Springer. pp. 226–. [ISBN](https:\/\/en.wikipedia.org\/wiki\/ISBN_\\(identifier\\) \"ISBN (identifier)\")\n   \n   [978-3-319-19668-8](https:\/\/en.wikipedia.org\/wiki\/Special:BookSources\/978-3-319-19668-8 \"Special:BookSources\/978-3-319-19668-8\")\n   \n   .\n7. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-aann.org_7-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-aann.org_7-1)\n   \"Care of the Patient Undergoing Intracranial Pressure Monitoring\/ External Ventricular Drainage or Lumbar Drainage\". *AANN Clinical Practice Guideline Series*. American Association of Neuroscience Nurses. 23 October 2012 \\[accessed\\].\n8. **[^](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-8)**\n   [Olson, DaiWai M.](https:\/\/en.wikipedia.org\/wiki\/DaiWai_Olson \"DaiWai Olson\"); Zomorodi, Meg; Britz, Gavin W.; Zomorodi, Ali R.; Amato, Anthony; Graffagnino, Carmelo (October 2013). [\"Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage\"](https:\/\/doi.org\/10.3171%2F2013.6.JNS122403). *Journal of Neurosurgery*. **119** (4): 974–980\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.3171\/2013.6.JNS122403](https:\/\/doi.org\/10.3171%2F2013.6.JNS122403). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [23957382](https:\/\/pubmed.ncbi.nlm.nih.gov\/23957382).\n9. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-pmid26069848_9-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-pmid26069848_9-1)\n   Muralidharan R (2015). [\"External ventricular drains: Management and complications\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4450504). *Surgical Neurology International*. **6** (Suppl 6): S271–4. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.4103\/2152-7806.157620](https:\/\/doi.org\/10.4103%2F2152-7806.157620). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\\(identifier\\) \"PMC (identifier)\") [4450504](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4450504). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [26069848](https:\/\/pubmed.ncbi.nlm.nih.gov\/26069848).\n10. **[^](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-pmid18728595_10-0)**\n    Kakarla UK, Kim LJ, Chang SW, Theodore N, Spetzler RF (2008). \"Safety and accuracy of bedside external ventricular drain placement\". *Neurosurgery*. **63** (suppl\\_1): ONS162–6, discussion ONS166–7. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1227\/01.NEU.0000312390.83127.7F](https:\/\/doi.org\/10.1227%2F01.NEU.0000312390.83127.7F). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [18728595](https:\/\/pubmed.ncbi.nlm.nih.gov\/18728595). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [71985774](https:\/\/api.semanticscholar.org\/CorpusID:71985774).\n11. **[^](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-11)**\n    Babu, Maya A.; Patel, Robin; Marsh, W. Richard; Wijdicks, Eelco F. M. (2012-02-01). \"Strategies to decrease the risk of ventricular catheter infections: a review of the evidence\". *Neurocritical Care*. **16** (1): 194–202\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1007\/s12028-011-9647-z](https:\/\/doi.org\/10.1007%2Fs12028-011-9647-z). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [1556-0961](https:\/\/search.worldcat.org\/issn\/1556-0961). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [22045248](https:\/\/pubmed.ncbi.nlm.nih.gov\/22045248). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [43099710](https:\/\/api.semanticscholar.org\/CorpusID:43099710).\n12. **[^](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-12)**\n    Beer, R.; Lackner, P.; Pfausler, B.; Schmutzhard, E. (2008-11-01). [\"Nosocomial ventriculitis and meningitis in neurocritical care patients\"](https:\/\/doi.org\/10.1007%2Fs00415-008-0059-8). *Journal of Neurology*. **255** (11): 1617–1624\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1007\/s00415-008-0059-8](https:\/\/doi.org\/10.1007%2Fs00415-008-0059-8). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [0340-5354](https:\/\/search.worldcat.org\/issn\/0340-5354). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [19156484](https:\/\/pubmed.ncbi.nlm.nih.gov\/19156484). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [38800504](https:\/\/api.semanticscholar.org\/CorpusID:38800504).\n13. **[^](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-13)**\n    Flint, Alexander C.; Rao, Vivek A.; Renda, Natalie C.; Faigeles, Bonnie S.; Lasman, Todd E.; Sheridan, William (2013-06-01). \"A simple protocol to prevent external ventricular drain infections\". *Neurosurgery*. **72** (6): 993–999, discussion 999. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1227\/NEU.0b013e31828e8dfd](https:\/\/doi.org\/10.1227%2FNEU.0b013e31828e8dfd). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [1524-4040](https:\/\/search.worldcat.org\/issn\/1524-4040). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [23467249](https:\/\/pubmed.ncbi.nlm.nih.gov\/23467249). [S2CID](https:\/\/en.wikipedia.org\/wiki\/S2CID_\\(identifier\\) \"S2CID (identifier)\") [29117121](https:\/\/api.semanticscholar.org\/CorpusID:29117121).\n14. **[^](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-14)**\n    Flint, Alexander C.; Toossi, Shahed; Chan, Sheila L.; Rao, Vivek A.; Sheridan, William (2016-12-21). \"A simple infection control protocol durably reduces external ventricular drain infections to near-zero levels\". *World Neurosurgery*. **99**: 518–523\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.1016\/j.wneu.2016.12.042](https:\/\/doi.org\/10.1016%2Fj.wneu.2016.12.042). [ISSN](https:\/\/en.wikipedia.org\/wiki\/ISSN_\\(identifier\\) \"ISSN (identifier)\") [1878-8769](https:\/\/search.worldcat.org\/issn\/1878-8769). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [28012890](https:\/\/pubmed.ncbi.nlm.nih.gov\/28012890).\n15. **[^](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-15)**\n    [\"EVD Infection Control\"](http:\/\/www.cleanbrain.org\/). *www.cleanbrain.org*. Retrieved 2017-01-16.\n16. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-pmid24101284_16-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/External_ventricular_drain#cite_ref-pmid24101284_16-1)\n    Chai FY, Farizal F, Jegan T (2013). [\"Coma due to malplaced external ventricular drain\"](https:\/\/doi.org\/10.5137%2F1019-5149.JTN.5724-12.1). *Turkish Neurosurgery*. **23** (4): 561–563\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\\(identifier\\) \"Doi (identifier)\"):[10\\.5137\/1019-5149.JTN.5724-12.1](https:\/\/doi.org\/10.5137%2F1019-5149.JTN.5724-12.1). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\\(identifier\\) \"PMID (identifier)\") [24101284](https:\/\/pubmed.ncbi.nlm.nih.gov\/24101284).\n\n![](https:\/\/en.wikipedia.org\/wiki\/Special:CentralAutoLogin\/start?type=1x1&usesul3=1)\n\nRetrieved from \"<https:\/\/en.wikipedia.org\/w\/index.php?title=External_ventricular_drain&oldid=1297737845>\"\n\n[Categories](https:\/\/en.wikipedia.org\/wiki\/Help:Category \"Help:Category\"):\n\n- [Medical drains](https:\/\/en.wikipedia.org\/wiki\/Category:Medical_drains \"Category:Medical drains\")\n- [Neurosurgery](https:\/\/en.wikipedia.org\/wiki\/Category:Neurosurgery \"Category:Neurosurgery\")\n\nHidden categories:\n\n- [Articles with short description](https:\/\/en.wikipedia.org\/wiki\/Category:Articles_with_short_description \"Category:Articles with short description\")\n- [Short description matches Wikidata](https:\/\/en.wikipedia.org\/wiki\/Category:Short_description_matches_Wikidata \"Category:Short description matches Wikidata\")\n- [Articles needing additional references from October 2017](https:\/\/en.wikipedia.org\/wiki\/Category:Articles_needing_additional_references_from_October_2017 \"Category:Articles needing additional references from October 2017\")\n- [All articles needing additional references](https:\/\/en.wikipedia.org\/wiki\/Category:All_articles_needing_additional_references \"Category:All articles needing additional references\")\n- [Short description is different from Wikidata](https:\/\/en.wikipedia.org\/wiki\/Category:Short_description_is_different_from_Wikidata \"Category:Short description is different from Wikidata\")\n\n- This page was last edited on 28 June 2025, at 05:38 (UTC).\n- Text is available under the [Creative Commons Attribution-ShareAlike 4.0 License](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Text_of_the_Creative_Commons_Attribution-ShareAlike_4.0_International_License \"Wikipedia:Text of the Creative Commons Attribution-ShareAlike 4.0 International License\"); additional terms may apply. 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Boilerpipe Text	An external ventricular drain ( EVD ), [ 1 ] also known as a ventriculostomy or extraventricular drain , is a device used in neurosurgery to treat hydrocephalus and relieve elevated intracranial pressure when the normal flow of cerebrospinal fluid (CSF) inside the brain is obstructed. An EVD is a flexible plastic catheter placed by a neurosurgeon or neurointensivist and managed by intensive care unit (ICU) physicians and nurses. The purpose of external ventricular drainage is to divert fluid from the ventricles of the brain and allow for monitoring of intracranial pressure . An EVD must be placed in a center with full neurosurgical capabilities, because immediate neurosurgical intervention can be needed if a complication of EVD placement, such as bleeding, is encountered. EVDs are a short-term solution to hydrocephalus, and if the underlying hydrocephalus does not eventually resolve, it may be necessary to convert the EVD to a cerebral shunt , which is a fully internalized, long-term treatment for hydrocephalus. [ 2 ] The EVD catheter is most frequently placed by way of a twist-drill craniostomy placed at Kocher's point , a location in the frontal bone of the skull, with the goal of placing the catheter tip in the frontal horn of the lateral ventricle or in the third ventricle . [ 3 ] [ 4 ] The catheter is typically inserted on the right side of the brain, but in some cases a left-sided approach is used, and in other situations catheters are needed on both sides. [ 4 ] EVDs can be used to monitor intracranial pressure in patients with traumatic brain injury (TBI), [ 5 ] subarachnoid hemorrhage (SAH), [ 6 ] intracerebral hemorrhage (ICH), or other brain abnormalities that lead to increased CSF build-up. In draining the ventricle, the EVD can also remove blood products from the ventricular spaces. This is important because blood is an irritant to brain tissue and can cause complications such as vasospasm . The EVD is leveled to a common reference point that corresponds to the skull base, usually the tragus or external auditory meatus . The EVD is set to drain into a closed, graduated burette at a height corresponding to a particular pressure level, as prescribed by a healthcare professional, usually a neurosurgeon or neurointensivist . Leveling the EVD to a set pressure level is the basis for cerebrospinal fluid (CSF) drainage; hydrostatic pressure dictates CSF drainage. The fluid column pressure must be greater than the weight of the CSF in the system before drainage occurs. It is therefore important that family members and visitors understand the patient's head of bed position cannot be changed without assistance. [ 7 ] An example of a healthcare provider order regarding an EVD is: set EVD to drain CSF for ICP > 15 mm Hg, check and record cerebrospinal fluid drainage and intracranial pressure at least hourly. Continuous CSF drainage is associated with a higher risk of complications. [ 8 ] The cerebral perfusion pressure (CPP) can be calculated from data obtained from the EVD and systemic blood pressure. In order to calculate the CPP the intracranial pressure and mean arterial pressure (MAP) must be available. [ 7 ] C P P = M A P − I C P {\displaystyle CPP=MAP-ICP} Other areas that should be monitored are: signs and symptoms of intracranial hypertension, looking for any leaks in the EVD system to prevent infection from entering the brain, and changes in the amount and color of the CSF. A sudden increase in hourly output of CSF may indicate intracranial hypertension, bloody CSF may indicate recurrent aneurysm rupture, and cloudy CSF may indicate brain infection. [ 9 ] EVD placement is an invasive procedure. It is associated with several potential complications: Bleeding can occur along the EVD insertion tract or in the several layers of the meninges that prohibit passage into the brain. If drilling or dural puncture is not successful, the surgeon may dissect away dura and create a secondary bleed known as an epidural or subdural hemorrhage. Bleeding from EVD placement can be life-threatening and can require neurosurgical intervention in some cases. The risk of hemorrhage with EVD placement is increased if the patient suffers from coagulopathy . Mechanical complications from EVD placement can be categorized into: Malplacement of the EVD tube into the brain tissue instead of ventricles can occur in 10 to 40% of the cases. Therefore, computed tomography (CT), ultrasound, endoscopy, and stereotactic neuronavigation are used to minimize placement errors of EVD tubes. [ 9 ] Obstruction/occlusion of EVD commonly due to fibrinous/clot like material or kinking of the tube. The brain can swell due to pressure build up in the ventricles and permanent brain damage can occur. Physicians or nurses may have to adjust or flush these small diameter catheters to manage medical tube obstructions and occlusions at the intensive-care bedside. [ 10 ] After EVD placement, the drain is tunneled subcutaneously and secured with surgical sutures and/or surgical staples . However, it is possible for the EVD to dislodge or migrate. This will cause the tip of the drain to migrate away from its intended position and provide inaccurate ICP measurement or lead to occlusion of the drain. The EVD is a foreign body inserted into the brain, and as such it represents a potential portal for serious infection. Historically, the rate of infections associated with EVDs has been very high, ranging from 5% to > 20%. [ 11 ] [ 12 ] Infections associated with EVDs can progress to become a severe form of brain infection known as ventriculitis . Protocols designed to reduce the rate of EVD infections have been successful, applying infection control 'bundle' approaches to reduce the rate of infection to well less than 1%. [ 13 ] [ 14 ] [ 15 ] Although neurological deficits from passing the EVD catheter across the brain are uncommon, there can be an association of a patient's poor neurological status with EVD malplacement. [ 16 ] In one report, the EVD was inserted too deeply into the fourth ventricle; the authors hypothesized that the patient's coma was due to irritation of the recticular activating system . The patient's level of consciousness improved after the EVD was adjusted. [ 16 ]
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Find sources: ["External ventricular drain"](https://www.google.com/search?as_eq=wikipedia&q=%22External+ventricular+drain%22) – [news](https://www.google.com/search?tbm=nws&q=%22External+ventricular+drain%22+-wikipedia&tbs=ar:1) · [newspapers](https://www.google.com/search?&q=%22External+ventricular+drain%22&tbs=bkt:s&tbm=bks) · [books](https://www.google.com/search?tbs=bks:1&q=%22External+ventricular+drain%22+-wikipedia) · [scholar](https://scholar.google.com/scholar?q=%22External+ventricular+drain%22) · [JSTOR](https://www.jstor.org/action/doBasicSearch?Query=%22External+ventricular+drain%22&acc=on&wc=on) (October 2017) ([Learn how and when to remove this message](https://en.wikipedia.org/wiki/Help:Maintenance_template_removal "Help:Maintenance template removal")) \| Medical intervention \| External ventricular drain \| \|---\| \| [![](https://upload.wikimedia.org/wikipedia/commons/thumb/d/de/EVD-ICH.jpg/250px-EVD-ICH.jpg)](https://en.wikipedia.org/wiki/File:EVD-ICH.jpg)Drainage system showing bloody CSF due to intracranial hemorrhage \| \| \[[edit on Wikidata](https://www.wikidata.org/wiki/Q5422058 "d:Q5422058")\] \| An external ventricular drain (EVD),[\[1\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-1) also known as a [ventriculostomy](https://en.wikipedia.org/wiki/Ventriculostomy "Ventriculostomy") or extraventricular drain, is a device used in [neurosurgery](https://en.wikipedia.org/wiki/Neurosurgery "Neurosurgery") to treat [hydrocephalus](https://en.wikipedia.org/wiki/Hydrocephalus "Hydrocephalus") and relieve elevated [intracranial pressure](https://en.wikipedia.org/wiki/Intracranial_pressure "Intracranial pressure") when the normal flow of [cerebrospinal fluid](https://en.wikipedia.org/wiki/Cerebrospinal_fluid "Cerebrospinal fluid") (CSF) inside the [brain](https://en.wikipedia.org/wiki/Brain "Brain") is obstructed. An EVD is a flexible plastic catheter placed by a [neurosurgeon](https://en.wikipedia.org/wiki/Neurosurgery "Neurosurgery") or [neurointensivist](https://en.wikipedia.org/wiki/Neurointensive_care "Neurointensive care") and managed by [intensive care unit](https://en.wikipedia.org/wiki/Intensive_care_unit "Intensive care unit") (ICU) physicians and nurses. The purpose of external ventricular drainage is to divert fluid from the ventricles of the brain and allow for monitoring of [intracranial pressure](https://en.wikipedia.org/wiki/Intracranial_pressure "Intracranial pressure"). An EVD must be placed in a center with full neurosurgical capabilities, because immediate neurosurgical intervention can be needed if a complication of EVD placement, such as bleeding, is encountered. EVDs are a short-term solution to hydrocephalus, and if the underlying hydrocephalus does not eventually resolve, it may be necessary to convert the EVD to a [cerebral shunt](https://en.wikipedia.org/wiki/Cerebral_shunt "Cerebral shunt"), which is a fully internalized, long-term treatment for hydrocephalus.[\[2\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-pmid_19035711-2) ## EVD placement \[[edit](https://en.wikipedia.org/w/index.php?title=External_ventricular_drain&action=edit&section=1 "Edit section: EVD placement")\] The EVD catheter is most frequently placed by way of a twist-drill craniostomy placed at [Kocher's point](https://en.wikipedia.org/wiki/Kocher%27s_point "Kocher's point"), a location in the [frontal bone](https://en.wikipedia.org/wiki/Frontal_bone "Frontal bone") of the skull, with the goal of placing the catheter tip in the frontal horn of the [lateral ventricle](https://en.wikipedia.org/wiki/Lateral_ventricle "Lateral ventricle") or in the [third ventricle](https://en.wikipedia.org/wiki/Third_ventricle "Third ventricle").[\[3\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-KumarLevine2017-3)[\[4\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-Proctor2007-4) The catheter is typically inserted on the right side of the brain, but in some cases a left-sided approach is used, and in other situations catheters are needed on both sides.[\[4\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-Proctor2007-4) EVDs can be used to monitor intracranial pressure in patients with [traumatic brain injury](https://en.wikipedia.org/wiki/Traumatic_brain_injury "Traumatic brain injury") (TBI),[\[5\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-Sundstr%C3%B8mGr%C3%A4nde2012-5) [subarachnoid hemorrhage](https://en.wikipedia.org/wiki/Subarachnoid_hemorrhage "Subarachnoid hemorrhage") (SAH),[\[6\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-O'DonnellN%C3%A1cul2016-6) [intracerebral hemorrhage](https://en.wikipedia.org/wiki/Intracerebral_hemorrhage "Intracerebral hemorrhage") (ICH), or other brain abnormalities that lead to increased CSF build-up. In draining the ventricle, the EVD can also remove blood products from the ventricular spaces. This is important because blood is an irritant to brain tissue and can cause complications such as [vasospasm](https://en.wikipedia.org/wiki/Vasospasm "Vasospasm"). ## Ongoing care \[[edit](https://en.wikipedia.org/w/index.php?title=External_ventricular_drain&action=edit&section=2 "Edit section: Ongoing care")\] The EVD is leveled to a common reference point that corresponds to the skull base, usually the [tragus](https://en.wikipedia.org/wiki/Tragus_\(ear\) "Tragus (ear)") or [external auditory meatus](https://en.wikipedia.org/wiki/Ear_canal "Ear canal"). The EVD is set to drain into a closed, graduated burette at a height corresponding to a particular pressure level, as prescribed by a healthcare professional, usually a [neurosurgeon](https://en.wikipedia.org/wiki/Neurosurgery "Neurosurgery") or [neurointensivist](https://en.wikipedia.org/wiki/Neurointensive_care "Neurointensive care"). Leveling the EVD to a set pressure level is the basis for [cerebrospinal fluid](https://en.wikipedia.org/wiki/Cerebrospinal_fluid "Cerebrospinal fluid") (CSF) drainage; [hydrostatic pressure](https://en.wikipedia.org/wiki/Hydrostatic_pressure "Hydrostatic pressure") dictates CSF drainage. The fluid column pressure must be greater than the weight of the CSF in the system before drainage occurs. It is therefore important that family members and visitors understand the patient's head of bed position cannot be changed without assistance.[\[7\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-aann.org-7) An example of a healthcare provider order regarding an EVD is: set EVD to drain CSF for ICP \> 15 mm Hg, check and record cerebrospinal fluid drainage and [intracranial pressure](https://en.wikipedia.org/wiki/Intracranial_pressure "Intracranial pressure") at least hourly. Continuous CSF drainage is associated with a higher risk of complications.[\[8\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-8) The [cerebral perfusion pressure](https://en.wikipedia.org/wiki/Cerebral_perfusion_pressure "Cerebral perfusion pressure") (CPP) can be calculated from data obtained from the EVD and systemic blood pressure. In order to calculate the CPP the [intracranial pressure](https://en.wikipedia.org/wiki/Intracranial_pressure "Intracranial pressure") and [mean arterial pressure](https://en.wikipedia.org/wiki/Mean_arterial_pressure "Mean arterial pressure") (MAP) must be available.[\[7\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-aann.org-7) C P P \= M A P − I C P {\\displaystyle CPP=MAP-ICP} ![{\\displaystyle CPP=MAP-ICP}](https://wikimedia.org/api/rest_v1/media/math/render/svg/ba9e025c26bccc1626e8f75ee7c9458caa1a3021) Other areas that should be monitored are: signs and symptoms of intracranial hypertension, looking for any leaks in the EVD system to prevent infection from entering the brain, and changes in the amount and color of the CSF. A sudden increase in hourly output of CSF may indicate intracranial hypertension, bloody CSF may indicate recurrent aneurysm rupture, and cloudy CSF may indicate brain infection.[\[9\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-pmid26069848-9) ## Complications \[[edit](https://en.wikipedia.org/w/index.php?title=External_ventricular_drain&action=edit&section=3 "Edit section: Complications")\] EVD placement is an invasive procedure. It is associated with several potential complications: ### Bleeding \[[edit](https://en.wikipedia.org/w/index.php?title=External_ventricular_drain&action=edit&section=4 "Edit section: Bleeding")\] Bleeding can occur along the EVD insertion tract or in the several layers of the meninges that prohibit passage into the brain. If drilling or dural puncture is not successful, the surgeon may dissect away dura and create a secondary bleed known as an epidural or subdural hemorrhage. Bleeding from EVD placement can be life-threatening and can require neurosurgical intervention in some cases. The risk of hemorrhage with EVD placement is increased if the patient suffers from [coagulopathy](https://en.wikipedia.org/wiki/Coagulopathy "Coagulopathy"). ### Mechanical \[[edit](https://en.wikipedia.org/w/index.php?title=External_ventricular_drain&action=edit&section=5 "Edit section: Mechanical")\] Mechanical complications from EVD placement can be categorized into: - Malplacement Malplacement of the EVD tube into the brain tissue instead of ventricles can occur in 10 to 40% of the cases. Therefore, computed tomography (CT), ultrasound, endoscopy, and stereotactic neuronavigation are used to minimize placement errors of EVD tubes.[\[9\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-pmid26069848-9) - Obstruction Obstruction/occlusion of EVD commonly due to fibrinous/clot like material or kinking of the tube. The brain can swell due to pressure build up in the ventricles and permanent brain damage can occur. Physicians or nurses may have to adjust or flush these small diameter catheters to manage medical tube obstructions and occlusions at the intensive-care bedside.[\[10\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-pmid18728595-10) - Migration After EVD placement, the drain is tunneled subcutaneously and secured with [surgical sutures](https://en.wikipedia.org/wiki/Surgical_suture "Surgical suture") and/or [surgical staples](https://en.wikipedia.org/wiki/Surgical_staple "Surgical staple"). However, it is possible for the EVD to dislodge or migrate. This will cause the tip of the drain to migrate away from its intended position and provide inaccurate ICP measurement or lead to occlusion of the drain. ### Infection \[[edit](https://en.wikipedia.org/w/index.php?title=External_ventricular_drain&action=edit&section=6 "Edit section: Infection")\] The EVD is a foreign body inserted into the brain, and as such it represents a potential portal for serious infection. Historically, the rate of infections associated with EVDs has been very high, ranging from 5% to \> 20%.[\[11\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-11)[\[12\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-12) Infections associated with EVDs can progress to become a severe form of brain infection known as [ventriculitis](https://en.wikipedia.org/wiki/Ventriculitis "Ventriculitis"). Protocols designed to reduce the rate of EVD infections have been successful, applying [infection control](https://en.wikipedia.org/wiki/Infection_control "Infection control") 'bundle' approaches to reduce the rate of infection to well less than 1%.[\[13\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-13)[\[14\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-14)[\[15\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-15) ### Neurological \[[edit](https://en.wikipedia.org/w/index.php?title=External_ventricular_drain&action=edit&section=7 "Edit section: Neurological")\] Although neurological deficits from passing the EVD catheter across the brain are uncommon, there can be an association of a patient's poor neurological status with EVD malplacement.[\[16\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-pmid24101284-16) In one report, the EVD was inserted too deeply into the fourth ventricle; the authors hypothesized that the patient's coma was due to irritation of the [recticular activating system](https://en.wikipedia.org/wiki/Reticular_activating_system "Reticular activating system"). The patient's level of consciousness improved after the EVD was adjusted.[\[16\]](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_note-pmid24101284-16) ## References \[[edit](https://en.wikipedia.org/w/index.php?title=External_ventricular_drain&action=edit&section=8 "Edit section: References")\] 1. [^](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-1) Logan CM, Rice MK (1987). Logan's Medical and Scientific Abbreviations (Hardbound book). [J. B. Lippincott](https://en.wikipedia.org/wiki/J._B._Lippincott_%26_Co. "J. B. Lippincott & Co."). p. 183. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [0-397-54589-4](https://en.wikipedia.org/wiki/Special:BookSources/0-397-54589-4 "Special:BookSources/0-397-54589-4") . 2. [^](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-pmid_19035711_2-0) Rammos, S; et al. (2008), "Conversion of external ventricular drains to ventriculoperitoneal shunts after aneurysmal subarachnoid hemorrhage: effects of site and protein/red blood cell counts on shunt infection and malfunction", J Neurosurg, 109 (6): 1001–1004, [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.3171/JNS.2008.109.12.1001](https://doi.org/10.3171%2FJNS.2008.109.12.1001), [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [19035711](https://pubmed.ncbi.nlm.nih.gov/19035711), [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [34114285](https://api.semanticscholar.org/CorpusID:34114285). 3. [^](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-KumarLevine2017_3-0) Monisha Kumar; Joshua Levine; James Schuster; W. Andrew Kofke (20 January 2017). [Neurocritical Care Management of the Neurosurgical Patient E-Book](https://books.google.com/books?id=6a74DQAAQBAJ&pg=PA265). Elsevier Health Sciences. pp. 265–. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-323-32222-5](https://en.wikipedia.org/wiki/Special:BookSources/978-0-323-32222-5 "Special:BookSources/978-0-323-32222-5") . 4. ^ [*a](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-Proctor2007_4-0) [b](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-Proctor2007_4-1) Mark R. Proctor (23 November 2007). [Minimally Invasive Neurosurgery](https://books.google.com/books?id=kz54UMcjHSsC&pg=PA402). Springer Science & Business Media. pp. 402–. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-1-59259-899-1](https://en.wikipedia.org/wiki/Special:BookSources/978-1-59259-899-1 "Special:BookSources/978-1-59259-899-1") . 5. [^](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-Sundstr%C3%B8mGr%C3%A4nde2012_5-0)* Terje Sundstrøm; Per-Olof Grände; Niels Juul; Carsten Kock-Jensen, Bertil Romner and Knut Wester (25 June 2012). [Management of Severe Traumatic Brain Injury: Evidence, Tricks, and Pitfalls](https://books.google.com/books?id=73UnMpOkf24C&pg=PA120). Springer Science & Business Media. pp. 120–. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-3-642-28126-6](https://en.wikipedia.org/wiki/Special:BookSources/978-3-642-28126-6 "Special:BookSources/978-3-642-28126-6") . 6. [^](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-O'DonnellN%C3%A1cul2016_6-0) John M. O'Donnell; Flávio E. Nácul (12 July 2016). [Surgical Intensive Care Medicine](https://books.google.com/books?id=sbGqDAAAQBAJ&pg=PA226). Springer. pp. 226–. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-3-319-19668-8](https://en.wikipedia.org/wiki/Special:BookSources/978-3-319-19668-8 "Special:BookSources/978-3-319-19668-8") . 7. ^ [*a](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-aann.org_7-0) [b](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-aann.org_7-1) "Care of the Patient Undergoing Intracranial Pressure Monitoring/ External Ventricular Drainage or Lumbar Drainage". AANN Clinical Practice Guideline Series. American Association of Neuroscience Nurses. 23 October 2012 \[accessed\]. 8. [^](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-8)* [Olson, DaiWai M.](https://en.wikipedia.org/wiki/DaiWai_Olson "DaiWai Olson"); Zomorodi, Meg; Britz, Gavin W.; Zomorodi, Ali R.; Amato, Anthony; Graffagnino, Carmelo (October 2013). ["Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage"](https://doi.org/10.3171%2F2013.6.JNS122403). Journal of Neurosurgery. 119 (4): 974–980\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.3171/2013.6.JNS122403](https://doi.org/10.3171%2F2013.6.JNS122403). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [23957382](https://pubmed.ncbi.nlm.nih.gov/23957382). 9. ^ [*a](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-pmid26069848_9-0) [b](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-pmid26069848_9-1) Muralidharan R (2015). ["External ventricular drains: Management and complications"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450504). Surgical Neurology International. 6* (Suppl 6): S271–4. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.4103/2152-7806.157620](https://doi.org/10.4103%2F2152-7806.157620). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4450504](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450504). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26069848](https://pubmed.ncbi.nlm.nih.gov/26069848). 10. [^](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-pmid18728595_10-0) Kakarla UK, Kim LJ, Chang SW, Theodore N, Spetzler RF (2008). "Safety and accuracy of bedside external ventricular drain placement". Neurosurgery. 63 (suppl\_1): ONS162–6, discussion ONS166–7. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1227/01.NEU.0000312390.83127.7F](https://doi.org/10.1227%2F01.NEU.0000312390.83127.7F). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [18728595](https://pubmed.ncbi.nlm.nih.gov/18728595). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [71985774](https://api.semanticscholar.org/CorpusID:71985774). 11. [^](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-11) Babu, Maya A.; Patel, Robin; Marsh, W. Richard; Wijdicks, Eelco F. M. (2012-02-01). "Strategies to decrease the risk of ventricular catheter infections: a review of the evidence". Neurocritical Care. 16 (1): 194–202\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s12028-011-9647-z](https://doi.org/10.1007%2Fs12028-011-9647-z). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [1556-0961](https://search.worldcat.org/issn/1556-0961). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22045248](https://pubmed.ncbi.nlm.nih.gov/22045248). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [43099710](https://api.semanticscholar.org/CorpusID:43099710). 12. [^](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-12) Beer, R.; Lackner, P.; Pfausler, B.; Schmutzhard, E. (2008-11-01). ["Nosocomial ventriculitis and meningitis in neurocritical care patients"](https://doi.org/10.1007%2Fs00415-008-0059-8). Journal of Neurology. 255 (11): 1617–1624\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s00415-008-0059-8](https://doi.org/10.1007%2Fs00415-008-0059-8). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [0340-5354](https://search.worldcat.org/issn/0340-5354). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [19156484](https://pubmed.ncbi.nlm.nih.gov/19156484). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [38800504](https://api.semanticscholar.org/CorpusID:38800504). 13. [^](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-13) Flint, Alexander C.; Rao, Vivek A.; Renda, Natalie C.; Faigeles, Bonnie S.; Lasman, Todd E.; Sheridan, William (2013-06-01). "A simple protocol to prevent external ventricular drain infections". Neurosurgery. 72 (6): 993–999, discussion 999. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1227/NEU.0b013e31828e8dfd](https://doi.org/10.1227%2FNEU.0b013e31828e8dfd). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [1524-4040](https://search.worldcat.org/issn/1524-4040). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [23467249](https://pubmed.ncbi.nlm.nih.gov/23467249). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [29117121](https://api.semanticscholar.org/CorpusID:29117121). 14. [^](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-14) Flint, Alexander C.; Toossi, Shahed; Chan, Sheila L.; Rao, Vivek A.; Sheridan, William (2016-12-21). "A simple infection control protocol durably reduces external ventricular drain infections to near-zero levels". World Neurosurgery. 99: 518–523\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.wneu.2016.12.042](https://doi.org/10.1016%2Fj.wneu.2016.12.042). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [1878-8769](https://search.worldcat.org/issn/1878-8769). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28012890](https://pubmed.ncbi.nlm.nih.gov/28012890). 15. [^](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-15) ["EVD Infection Control"](http://www.cleanbrain.org/). www.cleanbrain.org. Retrieved 2017-01-16. 16. ^ [*a](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-pmid24101284_16-0) [b](https://en.wikipedia.org/wiki/External_ventricular_drain#cite_ref-pmid24101284_16-1) Chai FY, Farizal F, Jegan T (2013). ["Coma due to malplaced external ventricular drain"](https://doi.org/10.5137%2F1019-5149.JTN.5724-12.1). Turkish Neurosurgery. 23* (4): 561–563\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.5137/1019-5149.JTN.5724-12.1](https://doi.org/10.5137%2F1019-5149.JTN.5724-12.1). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24101284](https://pubmed.ncbi.nlm.nih.gov/24101284). ![](https://en.wikipedia.org/wiki/Special:CentralAutoLogin/start?type=1x1&usesul3=1) Retrieved from "<https://en.wikipedia.org/w/index.php?title=External_ventricular_drain&oldid=1297737845>" [Categories](https://en.wikipedia.org/wiki/Help:Category "Help:Category"): - [Medical drains](https://en.wikipedia.org/wiki/Category:Medical_drains "Category:Medical drains") - [Neurosurgery](https://en.wikipedia.org/wiki/Category:Neurosurgery "Category:Neurosurgery") Hidden categories: - [Articles with short description](https://en.wikipedia.org/wiki/Category:Articles_with_short_description "Category:Articles with short description") - [Short description matches Wikidata](https://en.wikipedia.org/wiki/Category:Short_description_matches_Wikidata "Category:Short description matches Wikidata") - [Articles needing additional references from October 2017](https://en.wikipedia.org/wiki/Category:Articles_needing_additional_references_from_October_2017 "Category:Articles needing additional references from October 2017") - [All articles needing additional references](https://en.wikipedia.org/wiki/Category:All_articles_needing_additional_references "Category:All articles needing additional references") - [Short description is different from Wikidata](https://en.wikipedia.org/wiki/Category:Short_description_is_different_from_Wikidata "Category:Short description is different from Wikidata") - This page was last edited on 28 June 2025, at 05:38 (UTC). - Text is available under the [Creative Commons Attribution-ShareAlike 4.0 License](https://en.wikipedia.org/wiki/Wikipedia:Text_of_the_Creative_Commons_Attribution-ShareAlike_4.0_International_License "Wikipedia:Text of the Creative Commons Attribution-ShareAlike 4.0 International License"); additional terms may apply. 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