Note: This guideline is currently under review.

• Introduction
• Aim
  
• Definition of terms
  
• Indications
  
• Contraindications
  
• Assessment
  
• Management
  
• External Ventricular Drain (EVD)
• Transportation
  
• Levelling the EVD system
• CSF sampling from the EVD
• Changing the EVD System set
• Complications
• Removal of EVD
• ICP monitoring
• Reading ICP
• Removal of ICP monitor lines
• Lumbar drainage devices
• References
• Evidence table
  
• Companion Documents
  
  

Introduction

The cranial vault contains brain tissue, blood and cerebrospinal fluid (CSF). After closure of a child’s sutures, the cranial vault is similar to a rigid box. As the volume of the three components within the skull (brain matter, blood and CSF) must remain equal, an increase in one component must be accompanied by a decrease in another component. If there is not, an increase in intracranial pressure (ICP) will occur. 

ICP can be monitored via a fibre optic monitor (Codman™ microsensor) which is placed on the surface of the brain or in the brain or an external ventricular drain (EVD) system which is a closed sterile system allowing drainage of CSF via a silastic catheter tip which rests in the ventricle. 

The ventricular system produces CSF at approximately 20mL/hr (estimated at 0.35mL/min in children) by the choroid plexus in the lateral ventricles. The CSF circulates around the brain and spinal cord and is then reabsorbed via the arachnoid villi. 

Aim

This guideline is aimed at RCH staff involved in the use and management of EVD and ICP monitoring.

Definition of terms

• External ventricular drain (EVD): A temporary system that allows drainage of cerebral spinal fluid (CSF) from the ventricles to an external closed system.
  
• Intracranial pressure (ICP) monitoring: A temporary device allowing measurement and recording of intracranial pressure.
  
• Lumbar drainage devices: A temporary device allowing drainage of cerebral spinal fluid (CSF) from the subarachnoid space to an external closed system.
  
• Hydrocephalus: A disorder of the CSF circulation leading to raised pressure in the CSF. Whilst this is commonly associated with enlargement of the ventricle, in some circumstances the ventricles do not increase in size. 
  
• Meningitis: An inflammation or infection of the protective membranes and fluid that surround the brain
• Standard Aseptic Technique: Aims to prevent pathogenic microorganisms in sufficient quantity to cause infection, from being introduced to susceptible sites by hands, surfaces and equipment.
  

Indications

An EVD may be used:

• In cases of Hydrocephalus 
• Following surgery, particularly tumour surgery, until the CSF circulation is re-established
• To enable drainage of infected CSF (e.g. meningitis)
• In patients with a severe head injury to provide both a means of measuring ICP and allowing CSF drainage to treat raised ICP
  

An ICP monitoring probe may be placed either at the same time as an EVD or separately, in patients where monitoring ICP is vital. ICP monitoring may be used in patients with:

• Severe traumatic brain injury
  
• Complex hydrocephalus
• BIH (Benign intracranial hypertension)
  
• Patients who may need an objective 48hours of monitoring of their ICP to help clarify symptoms or the significance of scan findings
  

A lumbar CSF drain may be used for treatment of CSF leak as part of post-operative care, or in some circumstances, if a ventricular drain is contraindicated.

Contraindications

An EVD/ICP monitor is contraindicated in the following patients:

• The patient is receiving anticoagulation therapy or who are known to have coagulation problems.
  
• The patient has a scalp infection.
  

A lumbar catheter for drainage and monitoring of CSF is contraindicated in the following patients:

• The patient with non-communicative hydrocephalus.
  
• In the presence of a mass lesion such as a brain tumour.
  
• Patients with Chiari Malformation or tonsillar ectopia.
  
• In the presence of infection in the surrounding area which includes the skin, subcutaneous tissue, bone and the epidural space.
  

Assessment

Physical assessment including completing ABCD and neurological assessment on the paediatric patient with an EVD/ICP monitor and documenting is required at the beginning of each shift and PRN in relation to the patient’s condition. See Nursing Assessment guideline for more information.

Increased ICP is usually defined as sustained rises above 15mmHg. Common clinical signs of early intracranial hypertension include; headache, vomiting, irritability, seizures, photophobia, lethargy, nystagmus, and diplopia.

With severe intracranial hypertension, consciousness becomes depressed, tone and reflexes of the limbs are altered, pupils enlarge, papillary reaction to light is sluggish and spontaneous movement of the limbs is decreased. Signs may be unilateral or bilateral depending on the cause of the intracranial hypertension.

At a critically high level of ICP, spontaneous respiration is depressed, hypertension occurs, and heart rate is slowed, this is known as Cushing’s triad. Infants who have non-fused suture lines with open fontanel’s have a degree of compensation before signs of increased ICP are evident, such as macrocephaly.

Management

Management of raised ICP may include drainage of CSF if an EVD is in place. Other management may include:

• Urgent surgical decompression of a space occupying lesion (e.g. haematoma).
  
• Administration of a hyperosmolar agent (e.g. mannitol or hypertonic saline).
  
• Temporary mechanical hyperventilation (which lowers CO² tension in blood and causes cerebral vasoconstriction). Note- as the cerebral vasoconstriction reduces oxygen delivery to the brain, this should be employed for only short periods of time whilst instituting other measures.
  
• Serum sodium maintained at 140-145.
  
• Sedation and muscle relaxation (PICU/NICU only).
  
• Therapeutic hypothermia (although less evidence supporting this).
  

When an ICP monitor has been inserted in the operating theatre, upon admission to the recovery room or return to the PICU, NICU or Cockatoo ward, it is imperative that the patient be monitored closely with routine post anaesthetic observations as per operation notes and neurological assessment. See Routine post anaesthetic observation Clinical Guidelines (Nursing).

External ventricular drains (EVD)

Setting Up

Patients will usually arrive on the unit from the operating theatre with the EVD insitu, if the EVD is not set up; seek advice from the AUM, CSN or CNS.

Mandatory Checks (Treatment Orders)

At the beginning of each shift it is the responsibility of the nurse RN caring for a patient with an EVD to complete the following mandatory safety checks:

• Patient has a valid EVD order set on EMR that includes; height (value), height (units), reference point (e.g. Tragus), drainage (e.g. continuous), notify RMO if drainage is greater than (mL/hr).
  
• Reportable limits are noted and adhered which is patient specific.
  
• EVD drainage point is set at the prescribed level (as per Neurosurgeon documentation in postoperative orders).
  
• EVD transducer is levelled to the patient’s external auditory meatus (Tragus).
  
• EVD column is oscillating and patent.
  
• Head dressing is dry and intact.
• Report any signs of changes in patient’s neurological condition to the Medical team.
  

Documentation

It is imperative that the management of the drain is documented hourly.
Hourly documentation must include:

• Drain status (e.g. clamped/unclamped).
  
• Drain levelled (e.g. tragus/ mid sagittal line).
  
• Drain height (cmH2O).
  
• Hourly output (mL).
  
• CSF appearance (e.g. rosé, clear, cloudy)
  
• Is the drain oscillating?
  
• Patient position (e.g. supine, lateral, sitting up in chair).
  
• Patient state (e.g. alert, crying, settled, c/o headache).
  
• Dressing status (e.g. dry and intact, old ooze).
  
• Dressing intervention.
  

Transportation 

When a patient with an EVD is being transported off the ward, the patient MUST be accompanied by a competent RN. This RN must stay with the patient at all times until handed over to another accredited person.

Levelling the EVD system

The pressure transducer of the EVD must be maintained at the same horizontal level as the ventricles to ensure reliable interpretation of its value. The laser level device should be in line with the patient's Foramen of Monro (FOM). If the patient is supine with their head neutral, level the EVD system to the tragus of the ear. If the patient is lateral, level the EVD to the mid sagittal line (between the eyebrows). Every time the patient moves the EVD must be re-levelled.

Errors in positioning the transducer

• Too far above the FOM will lead to a falsely low ICP measurement and insufficient drainage of CSF – in this case intracranial hypertension would go undetected and untreated.
• Too far below the FOM will lead to a falsely high ICP measurement and excessive drainage of CSF – with subsequent collapsing of the ventricles with perhaps blockage of the system and unnecessary other treatment.

Procedure

1. Explain to the patient/family what is about to occur
2. Turn on the laser (protect the child’s eyes from the laser)
3. Ensure the spirit level is horizontal and the bubble is centred between the lines
4. Turn the 3-way tap between the patient and the burette on the EVD system, to the off position, preventing the flow of CSF
5. Alter the height of the entire EVD system to bring the transducer laser horizontal with the patient’s FOM (supine = tragus of the ear, lateral = mid sagittal line, between the eyebrows)
6. Once levelled, turn the 3-way tap between the patient and the burette on the EVD system, to the on position, allowing the flow of CSF
7. This procedure needs to be followed at the beginning of the shift, hourly and every time the patient moves or is moved.

CSF Sampling from the EVD

Introduction

CSF sampling must be conducted using standard aseptic technique every 24 hours (preferably in the AM) unless otherwise indicated by the Neurosurgeon. The procedure will require 1 – 2 registered nurses who are competent and confident with this procedure, having previously completed their EVD and CVAD competencies.
N.B. If patient has minimal drainage: consider clamping EVD 10-15 minutes prior to sampling to assist with collection of CSF as the patients ICP will increase, enabling a sample to be obtained more easily. To maintain patient safety, ensure this is discussed with the AUM.

** Under no circumstance is a sample to be obtained via aspiration, as the risk of aspirating brain parenchyma exists.

Equipment Required

• Sterile dressing pack
  
• x1 gauze pack
  
• Sterile gloves
  
• Sterile CSF tubes
  
• 10mL syringe
  
• x1 red cap
  

** If emptying CSF collection bag – require collection jug and one extra red cap
See: RCH Aseptic Technique Policy (RCH access only)

Procedure

1. Explain to the patient/family what is about to occur
   
2. Perform Hand Hygiene
3. Clean trolley/work surface with detergent and water or impregnated wipes
4. Identify and collect all equipment for procedure
   
5. Perform Hand Hygiene
   
6. Open sterile dressing pack by using corners
   
7. Peel open sterile equipment and drop onto sterile field using non-touch technique
   
8. Perform Clinical/Procedural Handwash with antimicrobial soap and don sterile gloves
   - Perform procedure ensuring all key parts are protected
   - Sterile items are used once and disposed of into waste bag
   - Only sterile key parts should contact disinfected or sterile key sites
   - Sterile items should not come into contact with non-sterile items
9. Ensure the EVD is off to the patient
   - Assistant RN to clamp the EVD and remove old Integra Stopcock Protection Box furthest   
        from the patient and hold line in air
   - Assistant RN to ensure 3-way tap at base of CSF collection chamber is closed to the 
        collection bag
   - Assistant RN to lift line and Operator RN to place sterile towel under line 
   N.B if collection bag needs to be emptied after CSF specimen is taken, also clean the access hub at the base of the bag with Chlorhexidine 0.5% in Alcohol 70% solution and allow antiseptic solution time to dry completely (this can take up to 2 minutes), AFTER you have collected the specimen then remove red cap and drain CSF into collection jug and replace with new sterile red cap. Ensure CSF is discarded into pan room macerator.
   
10. Operator RN to disinfect key part of Medtronic Exacta EVD kit 3 way tap with Chlorhexidine 0.5% in Alcohol 70% solution and allow antiseptic solution time to dry completely (this can take up to 2 minutes).
    
11. Cover with dry sterile gauze, the key part cap from side access hub (usually red cap) to be removed and discarded.
    
12. Disinfect access hub with Chlorhexidine 0.5% in Alcohol 70% solution and allow antiseptic solution time to dry completely (this can take up to 2 minutes).
    
13. Check the 3-way tap is off to the EVD system, therefore open to the patient (to collect to freshest CSF)
    
14. Collect minimum of 1mL (around 10 drops) CSF in sterile CSF tube. Never aspirate CSF from an EVD, allow drops to drip out
    
15. Turn 3-way tap off to side access hub
16. Disinfect access hub with Chlorhexidine 0.5% in Alcohol 70% solution and allow antiseptic solution time to dry completely (this can take up to 2 minutes).
    
17. Place new red cap on side access hub
18. Open 3-way tap from the patient to the drain
    
19. Assistant to open both Integra Stopcock Protection Boxes and fill with Betadine (iodine 1%) solution using 10mL syringe, close boxes
    
20. Ensure the EVD transducer is at a horizontal level to the Foramen of Monro
    
21. Turn the EVD on and ensure drain is oscillating/draining
    
22. Remove gloves and perform Hand Hygiene
    
23. Clean trolley, dispose of waste and perform Hand Hygiene
    
24. Label and send CSF specimen
    
25. Document procedure on EMR
    

Dressing changes

Dressings of the EVD site need to be observed hourly and this documented to ensure a leak has not occurred. If a leak is identified, place pressure combine/dressing and notify the AUM and Neurosurgical team. Dressings should be changed using sterile technique when soiled or otherwise directed by the Neurosurgical Medical team.

Changing the EVD system set 

The entire system needs to be changed using sterile technique every 7 days. The procedure will require 2 registered nurses who are competent and confident with this procedure.

Equipment

• x2 Sterile dressing pack
  
• Sterile gloves
  
• Extra Gauze
  
• Surgical steel clamp
  
• Chlorhexidine 0.5% in Alcohol 70% solution
  
• Medtronic Exacta EVD Kit (Stores Number: 309634)
  
• x2 Sterile Integra Stopcock protection boxes (External reference number: 901400)
• 30mls 0.9% Normal Saline
• x1 10mL syringe
  
• x1 30mL syringe
  
• Drawing up needle
  
• BetadineÔ (iodine 1%) solution

Procedure

Link: Aseptic Technique Policy & Procedure (RCH access only) 

1. Explain to the patient/ family what is about to occur
   
2. Perform Hand Hygiene
   
3. Clean trolley/work surface with detergent and water or impregnated wipes
   
4. Identify and collect all equipment for procedure
   
5. Perform Hand Hygiene
   
6. Open sterile dressing pack by using corners, ensure opened out to one end of trolley/work surface 
   
7. Open second dressing pack out on remainder of work surface/trolley to provide large sterile field
   
8. Peel open sterile equipment and drop onto sterile field using non-touch technique
   
9. Perform Clinical/Procedural Hand and don sterile gloves
   - Perform procedure ensuring all key parts are protected
   - Sterile items are used once and disposed of into waste bag
   - Only sterile key parts should contact disinfected or sterile key sites
   - Sterile items should not come into contact with non-sterile items
   
10. Operator RN to prime Medtronic Exacta EVD kit with 0.9% Normal Saline commencing at the patient line towards the short section of tubing (the end that connects to the ventricular catheter)
    
11. Rotate the patient line 3-way stopcock 180° so fluid can be pushed in the direction of the drip chamber, prime the patient line all the way through to the drip chamber
    
12. Ensure all 3-way taps are primed and the system has no air in it
    
13. Fill Integra Stopcock protection boxes with Betadine (iodine 1%) solution using a 10mL syringe
    
14. Assistant RN to clamp/turn off the EVD and remove old Integra Stopcock protection box closest to the patient and hold line in air
    
15. Assistant RN to use surgical steel clamp and gauze to clamp Silastic tubing as close to the patients head as possible and remove old Medtronic Exacta EVD kit from laser level device
    
16. Assistant to raise line and Operator to place sterile towel under line
    
17. Operator RN to clean the connection between Medtronic Exacta EVD set and silastic tubing with Chlorhexidine 0.5% in Alcohol 70% solution and allow antiseptic solution time to dry completely (this can take up to 2 minutes)
    
18. Disconnect old line (discard in clinical waste at end of procedure)
    
19. Scrub exposed end of silastic catheter using Chlorhexidine soaked gauze for 30 seconds, allow to air dry
    
20. Connect new Medtronic Exacta EVD kit to the patient
    
21. Ensure connection is secure
    
22. Apply new Integra Stopcock protection boxes to both sections of the Medtronic Exacta EVD kit
    
23. Fill both Stopcock boxes with Betadine (iodine 1%) solution and close both boxes
24. Ensure line is open to the patient (draining to the burette)
    
25. Load new Medtronic Exacta EVD kit into laser level device at appropriate H20 level/height as per Neurosurgeon’s instructions
26. Remove surgical steel clamp from silastic tubing at patient’s head
    
27. Ensure Medtronic Exacta EVD kit is levelled to the patient’s FOM
    
28. Turn on EVD and ensure it is oscillating or draining
    
29. Remove gloves and perform Hand Hygiene
    
30. Clean trolley, dispose of waste and perform Hand Hygiene
31. Document in EMR
    

Complications of EVD’S

Removal of EVD

1. Clamping EVD- Prior to removal of the EVD the Neurosurgery team may ask for the drain level to be altered or clamped, this needs to be clearly documented.
2. Once the patient has the EVD clamped, observe for signs and symptoms of increased ICP, CSF leak at dressing site and ensure the dressing is dry and intact.
3. Removal of EVD- When it is determined that the patient can have the EVD removed; this is completed by a member of the Neurosurgery team on the unit. The procedure is completed in the treatment room, under sterile conditions with appropriate pain relief, distraction and staff assistance. Post removal of the EVD, ensure the patient and wound site are observed and the dressing remains dry and intact.

ICP monitoring

Codman™ Monitor (ICP express) – is a device which enables measurement of pressure via a pressure transducer and fibre optic cable, but it does not have the ability to drain CSF as an EVD does. The monitor is usually placed in an extra-axial position (surface of the brain, e.g. subdural space) but it may be placed within the brain (parenchymal position) or within the CSF.

If the patient with an EVD requires ICP monitoring, attach and prime with 0.9% Normal Saline, via surgical aseptic procedure, attach the ICP transducer (Stores Number 7291) to the Medtronic Exacta EVD system at the 3-way tap parallel to the burette.

Mandatory checks (treatment orders)

At the beginning of each shift it is the responsibility of the RN caring for a patient with an ICP monitor to complete the following mandatory safety checks:

• Ensure the patient has a completed valid and correct treatment order on EMR.
  
• Ensure the head dressing is dry and intact.
  
• Ensure reportable limits are set on monitor and adhered to.
  
• Report any signs of changes in patient condition to the medical team.
  

Documentation of ICP

• Record ICP level hourly and document patients state e.g. asleep, crying, c/o headache.
  
• For an ICP monitor, the reading is taken directly from the ICP monitor (this should also correlate with the bedside Phillips monitor- if not, you may need to enter the 3-digit reference code on the ICP transducer.
  
• If the ICP is being printed, document on the print-out and on EMR every hour the patient’s ICP and patient’s position.
  
• If the patient’s ICP has a spike(s) (increased ICP reading), ensure this is documented at the time and add a description of the patient’s activity, inform the AUM and/or Neurosurgical team where required.
  

Setting up the ICP monitor

There are two types of ICP monitoring, a direct ICP monitor (Codman™) or via an EVD. An ICP monitor is utilized when ICP monitoring is needed without the need to drain CSF, e.g. investigation of headache. ICP monitoring can also be conducted via an EVD with the benefit of being able to drain excess CSF when necessary.

To enable printing with an ICP monitor, the ICP needs to be displayed on the bedside Phillips™ monitor which will then output to the printer.

Zeroing

Please note; the Codman™ microsensor ICP transducer is calibrated in theatre prior to insertion and must not be zeroed post this to avoid erroneous readings.

Reading ICP

Reading with an EVD

• When measuring and documenting ICP in a patient with an open EVD, it is crucial that the drainage to the burette system be clamped, enabling a true ICP reading to be obtained from the patient (otherwise the drainage pressure will be recorded).  Wait for the waveform to stabilize prior to documenting the reading (approximately 1 minute).
  
• Continuous CSF drainage and ICP measurements cannot be measured simultaneously (ICP cannot be measured if the EVD is on continuous drainage).
  
• Ensure the EVD is then reopened to allow continuous drainage.
  

Normal ranges/reportable limits

The normal range of ICP is 0-15mmHg; increased ICP is usually referred to as sustained above 15mmHg (refer to assessment section for clinical signs). 
 It is essential to refer to the reportable limits specific to the patient and notify the AUM / Neurosurgery team if a patient has a sustained increase in ICP or changes are noted during their regular observations.

* NB refer to the Traumatic Brain Injury Guideline (RCH access only) for more information on Cerebral Perfusion Pressure (CPP).

Dressing changes

Dressings of the ICP site need to be observed hourly and documented in EMR flowsheets to enable early detection of any leak. If a leak is identified, place pressure combine/dressing and notify the AUM and Neurosurgical team. Dressings should be changed sterilely as per Neurosurgeon or when soiled.

Removal of ICP monitor line

When it is determined that the patient can have the ICP catheter or device removed, this is performed by a member of the Neurosurgery team on the unit. The procedure is performed in the treatment room, under sterile conditions with appropriate pain relief, distraction and staff assistance. Ensure the site remains dry and no sign of CSF leak is evident.

* NB. Please clean and return all equipment (EVD measuring set, pole and ICP monitoring devices) to theatre upon finishing with patient monitoring.

Lumbar drainage devices

Lumbar drains can be indicated for insertion to assist with CSF leaks, evaluate the effect of reduced CSF pressure or as a temporary external shunt. As lumbar drains use the same circuits as EVD’s the management remains consistent with that of an EVD. However, the zero-point of lumbar drains is the insertion site, the drain will be most often at mattress level/ bed height therefore level with insertion site, and the patient is required to lay supine (flat on their back) to ensure accurate measuring. The Neurosurgical team will document parameters, drainage height or drainage volume.

References

• Adelson. P., et al. (2003). Intracranial pressure monitoring. Paediatric Critical Care, 4(3) (suppl.): S28-S3
  
• Alfred Health. (2014). Intracranial Pressure (ICP) Monitoring and Extraventricular Drains. 
  
• Hepburn-Smith, M., Dynkevich, I., Spektor, M., Lord, A., Czeisler, B., & Lewis, A. (2016). Establishment of an External Ventricular Drain Best Practice Guideline: The Quest for a Comprehensive, Universal Standard for External Ventricular Drain Care. The Journal of neuroscience nursing: journal of the American Association of Neuroscience Nurses, 48(1), 54–65. https://doi.org/10.1097/JNN.0000000000000174
  
• Humphrey, E. (2018). Caring for neurosurgical patients with external ventricular drains. Nursing Times, 114(4):52-56.
  
• Institute for healthcare Improvement. (2012). IHI central Line Bundle: Chlorhexidine Skin Antisepsis.
  
• Lewis, A., Czeisler, B., & Lord., A. (2017), Variations in Strategies to Prevent Ventriculostomy-Related Infections: A Practice Survey. The Neurohospitalist, 7(1), 15-23. Doi: 10.1177/1941874416663281
  
• Medtronic. (2018). Medtronic, exacta TM external drainage and monitoring system quick reference guide. Medtronic Inc.
  
• Muralidharan R. (2015). External ventricular drains: Management and complications. Surgical neurology international, 6(Suppl 6), S271–S274. https://doi.org/10.4103/2152-7806.157620
  
• Nag, D. S., Sahu, S., Swain, A., & Kant, S. (2019). Intracranial pressure monitoring: Gold standard and recent innovations. World journal of clinical cases, 7(13), 1535–1553. https://doi.org/10.12998/wjcc.v7.i13.1535
  
• O’Connor, Jody, (2019). Great Ormand Street Hospital. External Ventricular Drainage.
  
• Qalab, A., Asad, R., Hakeem,, M., Ahmad, M., Haq, A., Darbar, A. (2016). Paediatric external ventricular drains: experience from a tertiary care hospital of a developing country. JPMA: Journal of Pakistan Medical Association, 66(10), S-72-S-74
  
• Richardson. J., et al. (2012). External ventricular device guideline (EVD). Royal Hospital for Sick Children PICU-Neurosurgery: 1-16
  
• Royal Children’s Hospital. (2019). Policies and Procedures; Skin and surgical antisepsis.
  
• Royal Children’s Hospital. (2018). Policies and Procedures; Central Venous Access Device Management.
  
• Slazinski. T., et al. (2011) Care of the patient undergoing intracranial pressure monitoring/external ventricular drainage or lumbar drainage. American Association of Neuroscience Nurses: 1-37
  
• Tavakoli, S., Peitz, G., Ares, W., Hafeez, S., & Grandhi, R. (2017). Complications of invasive intracranial pressure monitoring devices in neurocritical care. Neurosurgical focus, 43(5), E6. https://doi.org/10.3171/2017.8.FOCUS17450
  
• The Children’s Hospital, Weastmead (2017). Intracranial Pressure (ICP) Monitoring via Rickham Resevoir, Codman Monitor or Lumbar Catheter- CHW. 
  
• Tippett. N. (2006). Intracranial pressure (ICP) monitoring and extraventricular drains (EVD). Bayside Health, Alfred ICU: 1-19 
  
• Western Health Sydney. (2003). Collection of CSF from a ventricular drain: Intensive care, evidence based practice guideline
  
• Yasuda, T., Tomita, T., McLone, D., & Donovan, M. (2002). Measurement of Cerebrospinal Fluid Output through External Ventricular Drainage in One Hundred Infants and Children: Correlation with Cerebrospinal Fluid Production. Pediatric Neurosurgery, 36(1), 22–28.
  

Evidence table

External Ventricular Drains and Intracranial Pressure Monitoring evidence table.

Companion Documents

• Nursing Competency Workbook- External Ventricular Drains and Intracranial Pressure Monitoring
• Medtronic: Exacta- external drainage and monitoring system- quick reference guide
• RCH -  Aseptic Technique Procedure
• RCH Nursing Guideline: Nursing Assessment
• RCH Nursing Guideline: Routine Post Anesthetic Observations 
• RCH Clinical Practice Nursing Guideline: Skin and Surgical Antisepsis
• RCH PICU Traumatic brain injury guideline: Care of the child with Traumatic Brain Injury in PICU

Please remember to read the disclaimer.

The revision of this nursing guideline was coordinated by Lauren Tunstall with the support of Cockatoo Ward. Authorised by Alison Wray, Head of Neurosurgery Department and approved by the Nursing Clinical Effectiveness Committee. Updated December 2020.