Table 1 Updated EVD Handling and Insertion Protocol, 2017
From: External ventriculostomy-associated infection reduction after updating a care bundle
Checklist (completed by nursing assistant) | Before EVD insertion 1. Informed consent signature 2. Date of insertion 3. Location of insertion (operating room, bedside, or Emergency Department) 4. Operator's Record (Senior or junior Surgeon) 5. Number of people in the room 6. Surgeon (hand washing, use of cap, mask, gloves, and sterile gown, plus change of gloves after placement of sterile field and before catheter insertion) 7. Assisting staff (Use of masks, hand washing, and gloves) 8. Patient preparation (wide shaving, washing with soap and water, paint with Betadine, field collation as a sterile blanket, and antibiotic prophylaxis administration): a. Cefuroxime, 1.5 g IV just before implantation as a single dose b. If allergies to cephalosporins, use vancomycin 1 g IV 60 min before the procedure |
EVD insertion (dressing change procedure) 1. EVD type 2. Drainage tunneling 3–5 cm from the insertion point 3. Fixation of the catheter with silk 2/03 4. Clean with chlorhexidine spray and connection to the collector system 5. Sterile protection of the first key of the collecting system for subsequent extraction of samples: a. Chlorhexidine spray b. Chlorhexidine-soaked gauze wrap c. Wrap with second protective gauze of the sterile area 6. Cover with chlorhexidine dressing (Tegaderm CHG 3M®) | |
Catheter care | 1. Perform head washing every 4 days with chlorhexidine soap 2. Healing of the insertion point. Changed every 4 days or whenever it is dirty, wet, or unhooked a. Patient mask placement b. The person performing the cure will wear a mask, wash their hands, and wear sterile gloves c. Use sterile drape and gauze, physiological saline, and chlorhexidine antiseptic solution (clean the insertion point with saline and disinfect the skin with 2% alcoholic chlorhexidine solution) d. Replace the transparent sterile dressing soaked in chlorhexidine (Tegaderm CHG 3M) e. If necessary, use a hair shaver for the area surrounding the drain, and use Nobecutan® and/or Cavilon™ to ensure adherence of the dressing 3. Healing of connections. Assess whenever the connection is used: a. Place a mask on the patient if necessary (not in intubated patients) b. The person who performs the cure will wear a mask, wash their hands, and wear sterile gloves c. Use sterile cloth and gauze with 70º alcohol solution to disinfect the connections and then protect with sterile gauze 4. Collection system change: replace the drainage bag when 3/4 full 5. Sampling will be done from the 7th day and then every 4 days if there are no signs of infection, and at any time in case of suspected infection: a. Clamp the catheter 15 min before extraction b. Disinfect the connections with 70º alcohol c. Extract the sample (≤ 5 cc) through the connection most proximal to the catheter, using gentle aspiration d. Use new caps for the 3-way faucets when they are opened |