Where do you level an EVD?

Levelling the EVD system 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).

How do you assess if an EVD is a patent?

Ensure the CSF oscillates with respiration. Ensure the CSF drips into the chamber. If there is no drainage, but the drain is patent, the meniscus of the CSF should be seen to swing because of pulsatile pressure. If the drainage is zero, and the CSF is not seen to swing, this could mean the drain is blocked.

What are the complications associated with an EVD?

Common complications following EVD insertion include haemorrhage, misplacement, dislodgement, blockage and infection, which could be further complicated by ventriculitis, meningitis, brain abscess or subdural empyema. These are associated with increased length of hospital stay, morbidity and mortality.

How do you troubleshoot a dampened ICP waveform?

To troubleshoot a dampened waveform, first examine the drainage tubing distal to the patient for the presence of air bubbles, clots, or tissue. If any are present, flush the tubing away from the patient to remove the debris or change the entire drainage system if necessary.

Why do we zero the EVD at the tragus?

‘Zero’ level defined by the tragus of the ear (at FORAMEN OF MAGENDIE) The objective is to use a ventriculostomy catheter and the EVD system to remove excess CSF and maintain normal CPP, while avoiding a rapid drop in ICP, which could cause re-bleeding.

How do you level an external ventricular drain?

Use a spirit level to ensure the main system stopcock on the drainage system (zero point) is level with the relevant anatomical reference point. Position the pressure level arrow at the top of the flow chamber at the prescribed height on the appropriate scale.