What is ventriculostomy used for?
Ventriculostomy is a procedure allowing for cerebrospinal fluid (CSF) drainage from the cerebral ventricles to alleviate elevated intracranial pressure secondary to communicating or non-communicating hydrocephalus.
What does ventriculostomy mean in medical terms?
A ventriculostomy is an artificially created opening between the cerebral ventricles and either a sterile extracranial space (drainage bag) or the intracranial subarachnoid space (ventriculocisternostomy). The external ventricular drain is the focus of this discussion.
Is a ventriculostomy a surgery?
Endoscopic third ventriculostomy is a surgical procedure offered to children and adults diagnosed with obstructive or non-communicating hydrocephalus.
How long is ventriculostomy procedure?
The procedure takes around 1 hour. There's less risk of infection after ETV than with shunt surgery. However, as with all surgical procedures, there are some risks.
Who needs a ventriculostomy?
Ventriculostomy is a neurosurgical procedure that involves creating a hole (stoma) within a cerebral ventricle for drainage. It is most commonly performed on those with hydrocephalus. It is done by surgically penetrating the skull, dura mater, and brain such that the ventricle of the brain is accessed.
When is a ventriculostomy needed?
A summary of indications for performing ventriculostomy is as follows: Acute symptomatic hydrocephalus - following subarachnoid hemorrhage (SAH), strokes, meningitis. Intracranial pressure (ICP) monitoring. Adjunct management for malfunctioning or infected ventriculoperitoneal shunts.
What are the risks of ventriculostomy?
The most significant risk of a ventriculostomy is infection; rates of 27% have been cited,10,18,20,21 although most reported rates are in the 1% to 10% range. Infection rates are similar regardless of procedure location (ICU or the operating room).
Is ventriculostomy permanent?
Ventriculostomy or ventricular drain is a quick surgical procedure performed in the head to attach a device to drain cerebrospinal fluid (CSF) buildup in the brain. This device may be placed externally, and it can be either temporary or permanent.
What causes ventriculostomy?
Predisposing factors that cause ETV failure are ventriculostomy stoma closure by new arachnoid granulation tissues, second membrane relics within the stoma, CSF absorption failure, CSF infection/high protein, and improper selection of patients.
How much does a ventriculostomy cost?
The average costs per patient in the group treated with ETV was USD$ 2,177,66±517.73 compared to USD$ 2,890.68±2,835.02 for the VPS group.
What is the best treatment for hydrocephalus?
The most common treatment for hydrocephalus is the surgical insertion of a drainage system, called a shunt. It consists of a long, flexible tube with a valve that keeps fluid from the brain flowing in the right direction and at the proper rate. One end of the tubing is usually placed in one of the brain's ventricles.
Can hydrocephalus cause death?
If left untreated, hydrocephalus can be fatal. Early diagnosis and successful treatment improve the chance for a good recovery. With the benefits of surgery, rehabilitative therapies, and educational interventions, many people with hydrocephalus live relatively normal lives.
What causes ventriculostomy?
Predisposing factors that cause ETV failure are ventriculostomy stoma closure by new arachnoid granulation tissues, second membrane relics within the stoma, CSF absorption failure, CSF infection/high protein, and improper selection of patients.
What are the risks of ventriculostomy?
The most significant risk of a ventriculostomy is infection; rates of 27% have been cited,10,18,20,21 although most reported rates are in the 1% to 10% range. Infection rates are similar regardless of procedure location (ICU or the operating room).
What is the difference between EVD and ventriculostomy?
An external ventricular drain (EVD), also known as a ventriculostomy or extraventricular drain, is a device used in neurosurgery to treat hydrocephalus and relieve elevated intracranial pressure when the normal flow of cerebrospinal fluid (CSF) inside the brain is obstructed.
What are 4 types of hydrocephalus?
The four main types of hydrocephalus are communicating hydrocephalus, non-communicating hydrocephalus, normal pressure hydrocephalus and hydrocephalus ex-vacuo. Communicating hydrocephalus occurs when the flow of CSF is blocked after it leaves your ventricles.
What is ventriculostomy?
Ventriculostomy is a surgery performed in both children and adults to reduce the excess cerebrospinal fluid (CSF) in ventricles of the brain. Ventricles are interconnected cavities in the brain, filled with CSF. There are four ventricles in the brain. Two lateral ventricles in either hemisphere of brain, a third ventricle that is connected to both these ventricles and the fourth ventricle that lies in the brain stem and is connected to the third ventricle via a channel called the cerebral aqueduct.
How is ventriculostomy done?
Once you reach the hospital, you will be asked to change into a hospital gown and wear non-skid socks. The surgery will be performed in the operation theatre. You will lie on the operating bed, and compression boots will be put on to help blood flow to your legs. You will be given general anaesthesia to make you fall asleep during the procedure. Then, your hair will be shaved on the area where the cut is to be made.
When to follow up with your doctor after a ventriculostomy?
A follow-up appointment will generally be scheduled for seven to 10 days after the surgery to remove the stitches or staples in your incision.
Where does the CSF flow in endoscopic third ventriculostomy?
Endoscopic third ventriculostomy. Most blockages in CSF flow occur in the slender pathway between the third and fourth ventricle. In endoscopic third ventriculostomy, the CSF is diverted from the third ventricle to the chambers beneath the base of the brain.
What is a ventriculoperitoneal shunt?
Additional management of infected or malfunctioning ventriculoperitoneal shunts (a medical device that is used to control pressure on the brain caused by fluid accumulation)
Which ventricle is connected to the third ventricle?
Two lateral ventricles in either hemisphere of brain, a third ventricle that is connected to both these ventricles and the fourth vent ricle that lies in the brain stem and is connected to the third ventricle via a channel called the cerebral aqueduct. The CSF protects and nourishes the brain.
Why do you put a mask on after a third ventriculostomy?
On waking up, you may feel tired. Next day after the endoscopic third ventriculostomy, the doctor will remove the bandage covering your incision, and it will be left uncovered.
How to take ventricle out?
The doctor will decide when it’s safe to take the ventric out. The doctor will remove the stitches and gently pull the tube out. A dressing will be placed over the site. The nurse will watch it for drainage and infection. A staple or two may be needed to keep the site from draining.
Why does the ventricle of the brain need to be good?
The fluid pushes against brain tissue and slows the blood flow. The brain needs good blood flow for a constant supply of oxygen and nutrients to work well . The ventric allows the healthcare team to drain off excess fluid.
Can you touch ventricles?
Do not touch your ventric while it is in place. Touching it may cause it to fall out, lead to infection, bleeding, or excessive drainage of fluid. Always ask the nurse to help with moving around, problems with the dressing, or itching at the site. Do not allow visitors to adjust your position or touch your drain.
What is a ventricular catheter?
Figure 116-1 The ventricular catheter is threaded through the brain to the ventricles. Placement of the tube allows for monitoring of ventricular pressure, draining of cerebrospinal fluid and blood, and providing a route for medication administration.
What happens if the CSF chamber is too low?
If the drip chamber is too low, inappropriate CSF decompression may occur leading to hemorrhage and/or pain. If the drip chamber is too high, the intracranial pressure may inappropriately increase leading to herniation and death.
Can ICP be read from ventriculostomy?
The physician may want to read and visualize ICP and waveforms from the ventriculostomy catheter. If so, the setup for ICP monitoring should be provided (see Chapter 52 ).
Is an external ventriculostomy drain a closed system?
An external ventriculostomy drain (EVD) is a closed system; therefore, sterility of the site and equipment must be maintained.
Does ventriculostomy drainage increase or decrease CSF drainage?
The amount of ventriculostomy drainage that occurs is partially based on gravity and partially based on the intracranial pressure. Lowering the drip chamber enhances CSF drainage. Raising the drip chamber reduces CSF drainage.
Why is my ventriculostomy catheter causing obstruction?
Obstruction of a ventriculostomy catheter is often due to cellular debris, such as blood clots and/or tissue fragments.
What is the nursing responsibility for EVD?
Maintenance, troubleshooting, and monitoring for EVD associated complications has essentially become a nursing responsibility. Accurate and accountable nursing care may have the ability to portend better outcomes in patients requiring CSF drainage.
How to do an EVD?
A freehand pass technique using surface landmarks is commonly used by surgeons to place an EVD.[7] The right frontal cerebral hemisphere is the preferred site of entry given its nondominance for language function in >90% of patients.[7,10] The patient is maintained with head of bed elevated at 45 degrees in the supine position. Hair is removed using clippers and the scalp is prepared in a sterile fashion.[10] A burr hole is placed at Kocher's point to avoid the superior sagittal sinus and frontal cortex motor strip.[7] This point is located by drawing one line in the midline from the nasion to a point 10 cm back and another from the previous point to a site 3 cm lateral to it, along the ipsilateral midpupillary line. After instillation of local anesthesia, a linear skin incision is made down to the bone and the periosteum is scraped. A twist drill is used to penetrate the cranium in the trajectory determined for ventricular cannulation, and the pia and dura are pierced with a scalpel. The ventricular catheter is primed and passed no more than 7 cm, aiming in a coronal plane toward the medical canthus of the ipsilateral eye and in the anteroposterior plane toward a point 1.5 cm anterior to the ipsilateral tragus, toward the ipsilateral Foramen of Monro. Once CSF flow is visualized after removal of catheter stylet, it can be transduced to obtain an opening intracranial pressure. It is then tunneled through the skin away from the point of entry through a separate incision, sutured securely in place, and then connected to an external drainage system.[10] Complications such as hemorrhage and inadvertent placement into brain tissue is reported in 10–40% of cases.[11] As a result, technical advances using computed tomography (CT), ultrasound, endoscopy, and stereotactic neuronavigation have been developed to improve the accuracy and efficiency of ventriculostomy placement.[7,11]
What is the purpose of a neurosurgeon draining blood and CSF?
Typically placed at the bedside by a neurosurgeon or neurointensivist using surface landmarks under emergent conditions, this procedure has the ability to drain blood and CSF to mitigate intracranial hypertension, continuously monitor intracranial pressure, and instill medications. Nursing should ensure proper zeroing, placement, sterility, and integrity of the EVD collecting system. ICP waveform analysis and close monitoring of CSF drainage are extremely important and can affect clinical outcomes of patients. In some institutions, nursing may also be responsible for CSF sampling and catheter irrigation.
What is external ventricular drain?
External ventricular drains are life-saving devices used in neurosurgical patients with hydrocephalus (excessive amounts of cerebrospinal fluid). The fluid is produced in the brain ventricles and circulates around the brain and spinal cord, protecting them from injury and supplying brain cells with nutrients.
Why is increased ventricular pressure important?
Raised ICP is critical because it reduces blood flow to the brain, starving it of oxygen, glucose and other vital substances.
Can over draining the ventricle cause haematoma?
Equally damaging for the patient is over-drainage, which can collapse the ventricle, pulling the brain tissue away from the dura, tearing cortical veins and leading to subdural haematoma (Woodward and Waterhouse, 2009). Over-drainage can be prevented by ensuring that the CSF is not draining at a lower pressure than that set by the neurosurgeon.
Is EVD invasive?
The insertion of an EVD is a highly invasive procedure and carries a significant risk of infection (Muralidharan, 2015; Chatzi et al, 2014; Wong, 2011); this risk increases the more frequently it is accessed by health professionals to obtain CSF samples (Jamjoom et al, 2017), and the longer the EVD is kept in situ (Camacho et al, 2010). Touching EVD components, such as the stopcock or drainage bag, must be an aseptic procedure and handling must be kept to a minimum (Woodward and Waterhouse, 2009).
When a patient with an EVD is being transported off the ward, the patient MUST be accompanied by?
When a patient with an EVD is being transported off the ward, the patient MUST be accompanied by a competent RN. This RN must stay with the patient at all times until handed over to another accredited person.
Where do patients go to get EVD?
Patients will usually arrive on the unit from the operating theatre with the EVD insitu, if the EVD is not set up; seek advice from the AUM, CSN or CNS.
What is the cranial vault?
The cranial vault contains brain tissue, blood and cerebrospinal fluid (CSF). After closure of a child’s sutures, the cranial vault is similar to a rigid box. As the volume of the three components within the skull (brain matter, blood and CSF) must remain equal, an increase in one component must be accompanied by a decrease in another component. If there is not, an increase in intracranial pressure (ICP) will occur.#N#ICP can be monitored via a fibre optic monitor (Codman™ microsensor) which is placed on the surface of the brain or in the brain or an external ventricular drain (EVD) system which is a closed sterile system allowing drainage of CSF via a silastic catheter tip which rests in the ventricle.#N#The ventricular system produces CSF at approximately 20mL/hr (estimated at 0.35mL/min in children) by the choroid plexus in the lateral ventricles. The CSF circulates around the brain and spinal cord and is then reabsorbed via the arachnoid villi.
Why do you need lumbar drains?
Lumbar drains can be indicated for insertion to assist with CSF leaks, evaluate the effect of reduced CSF pressure or as a temporary external shunt . As lumbar drains use the same circuits as EVD’s the management remains consistent with that of an EVD. However, the zero-point of lumbar drains is the insertion site, the drain will be most often at mattress level/ bed height therefore level with insertion site, and the patient is required to lay supine (flat on their back) to ensure accurate measuring. The Neurosurgical team will document parameters, drainage height or drainage volume.
How much CSF is produced in the ventricular system?
The ventricular system produces CSF at approximately 20mL/hr (estimated at 0.35mL/min in children) by the choroid plexus in the lateral ventricles. The CSF circulates around the brain and spinal cord and is then reabsorbed via the arachnoid villi.
What is Chiari Malformation?
In the presence of a mass lesion such as a brain tumour. Patients with Chiari Malformation or tonsillar ectopia. In the presence of infection in the surrounding area which includes the skin, subcutaneous tissue, bone and the epidural space.
Why is the EVD not oscillating?
If CSF output is less than documented reportable limits, the EVD Is not oscillating, or the ICP waveform is flat, the Neurosurgeon must be contacted immediately. Inadequate drainage of CSF may lead to an increased ICP. This can be due to a variety of reasons: a blockage in the system; accidentally clamped EVD; dislodgement from within the ventricles; CSF leak or rising pressure. Ensure the AUM and Neurosurgeon are notified (and PICU consultant if patient in PICU), and the patient is observed for signs of increased ICP.
