External Ventricular and Lumbar Drains: Indications, Procedures, and Patient Care

External ventricular and lumbar drains are used to relieve elevated intracranial pressure, usually due to a brain hemorrhage from acute trauma. This comprehensive guide covers indications, anatomy, planning, and procedure stages for each drain, helping you troubleshoot problems that can arise in patients who undergo this procedure.

Format: Paperback / softback
Length: 176 pages
Publication date: 13 October 2023
Publisher: McGraw-Hill Education

The most common point of contact with providers in neurocritical care units, trauma units, and emergency departments, external ventricular drains and lumbar drains are used to relieve elevated intracranial pressure, usually due to a brain hemorrhage from acute trauma.

Covering indications, anatomy, planning, and procedure stages for each drain, External Ventricular and Lumbar Drains: Indications, Procedures, and Patient Care helps you troubleshoot problems that can arise in patients who undergo this procedure. The authors provide thorough coverage of why these drains are placed, why they are placed in certain locations, how they are placed, and what steps to take when there is a malfunction. This comprehensive, easy-to-understand guide covers:

Cerebrospinal fluid anatomy.
Obstructive and communicating hydrocephalus.
Intracranial pressure monitoring.
Ventricular and lumbar entrance points.
EVD and LD equipment, patient positioning, procedure, and troubleshooting.

External ventricular drains (EVDs) and lumbar drains are commonly used in medical settings to manage elevated intracranial pressure, often in the aftermath of a brain hemorrhage or other traumatic injury. These drains are placed through a small incision in the skull or back to drain excess cerebrospinal fluid (CSF) from the brain.

The anatomy of the cerebrospinal fluid system is crucial in understanding the purpose and placement of EVDs and lumbar drains. CSF is a clear, colorless fluid that surrounds and cushions the brain and spinal cord. It is produced by the brain and absorbed by the arachnoid mater, a thin layer of tissue that covers the brain and spinal cord. The arachnoid mater is connected to the venous system, which drains CSF into the venous sinuses and ultimately into the venous circulation.

There are two main types of hydrocephalus: obstructive and communicating. Obstructive hydrocephalus occurs when there is a blockage in the flow of CSF, usually due to a blockage in the ventricular system. This can lead to an increase in intracranial pressure, which can be dangerous and even fatal. Communicating hydrocephalus occurs when there is a failure of the arachnoid mater to absorb CSF, which can lead to an accumulation of CSF in the subarachnoid space. This can also cause an increase in intracranial pressure.

EVDs are typically used to manage obstructive hydrocephalus. They are placed through a small incision in the skull, usually in the frontal or temporal lobes. The drain is connected to a subcutaneous reservoir, which collects the CSF and drains it into a bag outside the body. The reservoir is typically replaced every few days to maintain a constant flow of CSF.

Lumbar drains are typically used to manage communicating hydrocephalus. They are placed through a small incision in the back, usually in the lumbar region. The drain is connected to a subcutaneous reservoir, which collects the CSF and drains it into a bag outside the body. The reservoir is typically replaced every few days to maintain a constant flow of CSF.

Intracranial pressure monitoring is an essential component of the management of EVDs and lumbar drains. Intracranial pressure monitors are used to measure the pressure inside the skull and monitor changes in pressure over time. This information is used to adjust the placement and drainage rate of the drains to maintain a stable and safe level of intracranial pressure.

Patient positioning is also important in the management of EVDs and lumbar drains. Patients who are receiving EVDs may need to be positioned in a semi-fowler's position to prevent aspiration of CSF. Patients who are receiving lumbar drains may need to be positioned in a prone position to allow for proper drainage of CSF.

EVDs and lumbar drains are relatively safe and effective treatments for managing elevated intracranial pressure. However, there are some potential complications that can occur. These include infection, bleeding, and brain damage. Infection is a common complication of EVDs and lumbar drains, especially if the drains are not properly cleaned and maintained. Bleeding is also a potential complication, especially if the drains are placed in an area with a high blood supply. Brain damage is a rare but serious complication of EVDs and lumbar drains, especially if the drains are placed in an area with a high risk of bleeding.

In conclusion, external ventricular and lumbar drains are commonly used in medical settings to manage elevated intracranial pressure, often in the aftermath of a brain hemorrhage or other traumatic injury. The anatomy of the cerebrospinal fluid system is crucial in understanding the purpose and placement of these drains. Intracranial pressure monitoring is an essential component of the management of EVDs and lumbar drains, and patient positioning is also important. EVDs and lumbar drains are relatively safe and effective treatments, but there are some potential complications that can occur. It is important for healthcare providers to be aware of these potential complications and to take appropriate measures to prevent and manage them.

Weight: 268g
Dimension: 151 x 229 x 11 (mm)
ISBN-13: 9781264268290