EVD---EVD CARE ESPECAILLY IN ICU SETTINGS MORE ESSENTIAL , THIS PPT EXPLAINS YOU ABOUT EVD IN BRIEF, INDICATIONS, COMPLICATIONS , , EVD CARE PROCEDURE, NURSING DIAGNOSIS & MANGEMENT ASSOCIETED WITH EVD RELATED INFECTIONS ...
2. INTRODUCTION….
An External Ventricular drainage or ICP monitor is a
temporary method of draining of Cerebrospinal from the
ventricular system of the brain when the normal flow of
CSF altered….
the normal range of ICP is 0-15mmhg
An EVD system involves introducing a catheter into one
of the ventricles of the brain ..
> .This procedure is undertaken in OTs by Neurosurgery
team..
>.A EVD system may be connected to a butterfly
secured into a ventricular access device..
3. EVD Indications…..
common indications include raised Intra cranial
pressure(ICP):-
-. Head injury
-. Intracranial hemorrhage -. Acute hydrocephalus
-. cerebral or spinal tumors -. Meningitis or or ventriculitis or shunt
infection ..
Contraindications-
Patient is having any coagulation problems or patient is receiving
anticoagulation therapy
Patient is having scalp infections…
4. Positioning,Zeroing and Securing the EVD..
1.check all connections and tubings are secure ensuring that move
with the head ..
2. If intubated & ventilated means maintain head end elevation >30
degree
3.Establish correct zero reference point using visual landmarkings
“tragus of the ear”
4.Ensure that the chamber is at correct level on gauze as
prescribed by the neurosurgeon.This should be recorded in the
physicain notes as well as documented in the Nurses notes (
usually set at the 10-15cmH2o) ….
5. Mandatory checklists…
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 Medcal team
6. Documentation…..
It is imperative that the management of the drain is documented hourly. Follow TBI chart…
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) ,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.
7. Complications of EVD…..
1.infection ( fever,redness or exudate at the site)
2.blocked Drain
-.inadequate drainage ,tube block or accidentally clamped
3. Excess Drainage :- excessive drainage can lead to
collapsed ventricles , subdural haemorrhage or in some
cases upward herniation..
4. Fluid & electrolyte loss - sodium potassium loss
5.CSF leak
6.accidental removal of EVD
8. NURSING INTERVENTIONS…..
Interventions to lower or stabilize ICP include “elevating the head
of the bed to thirty degrees, keeping the neck in a neutral position,
maintaining a normal body temperature, and preventing volume
overload”
1.Monitor vital signs,GCS , Intake out chart & CSF drainage output chart hourly ,watch
for signs of ICP or LOC
2.frequently check EVD tube for any kink, blockage ,if identified inform immediately to
Intensivist or Neurosurgeon
3. DURING TRANSPORTATION, CHANGING THE POSITION, WHILE MAKING
PATIENT SUPINE please make sure EVD in CLAMPED status..
9. NURSING INTERVENTIONS…..
4.while handling with EVD CIRCUIT Prefer aseptic precautions like Hand hygeine , Hand washing
5.EVD Sampling should be done by NEUROSURGEON (as per policy)
6.Never inject anything
7.Hourly CSF drain output monitoring , suppose there is no output in 1 hour please check the tubing
& inform immeadiately to neurosurgery team, watch closley for patient GCS..
8.level of EVD should be adjusted by the Neurosurgeon,please make sure for clear
documentation
9. Follow TBI chart
10. Patient & family education
