An Evaluation of Commonly Used External Ventricular Drain Securement Methods in a Porcine Model: Recommendations to Improve Practice

World Neurosurgery
Danyal AkarcaDiederik O Bulters

Abstract

External ventricular drain (EVD) dislodgement is common and leads to significant morbidity and mortality. Many securement techniques to prevent this are described. There are, however, no objective studies comparing them. This study aimed to determine the most secure method of securing an EVD. A survey was distributed through the British Neurosurgical Trainee Research Collaborative to determine common EVD securement methods and select techniques for testing. Securement methods were tested in a pig cadaver model. Peak pull force before EVD failure was measured. Failure was defined as catheter displacement 1 cm from the insertion site, catheter fracture, or suture fracture. Twenty-three neurosurgical units responded. Five basic EVD securement methods were in common use. These were tested in isolation and in combination so that in total 15 common methods were tested. The most secure method was a triple construct, consisting of an anchoring suture, sutures around a coil of the catheter, and either a soft plastic flange (25.85 N, 95% confidence interval 24.95 N-26.75 N) or a hard plastic flange (29.05 N, 95% confidence interval 25.69 N-32.41 N). Of the individual methods, single anchoring sutures, soft flanges, VentriFix, and staples...Continue Reading

Citations

Oct 18, 2018·Annals of the Royal College of Surgeons of England·L HeskinK Bryan
Jun 18, 2020·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Paolo FrassanitoGianpiero Tamburrini
Jan 3, 2021·Acta neurochirurgica·Sebastian ArtsHieronymus D Boogaarts
Jul 4, 2021·Clinical Neurology and Neurosurgery·Mohamed M SalemAjith J Thomas

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