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An evaluation of commonly used external ventricular drain securement methods in a porcine model: Recommendations to improve practice

An evaluation of commonly used external ventricular drain securement methods in a porcine model: Recommendations to improve practice
An evaluation of commonly used external ventricular drain securement methods in a porcine model: Recommendations to improve practice
Background: 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.

Methods: 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.

Results: 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 were found to be the least secure, whereas multiple sutures and hard flanges were the most secure.

Conclusions: An anchoring suture followed by a coil of the catheter and finally a flange is the most secure method for securing EVDs. This simple technique can withstand up to 8.2 times the force of a single anchoring suture, is easily used, and decreases the likelihood of EVD dislodgement and associated complications.
Cerebrospinal fluid, External ventricular drain, Securement, Technique, Ventriculitis
1878-8750
e197-e202
Akarca, Danyal
d0cdcb85-5e96-4ed6-861c-d28ac0844f80
Durnford, Andrew J.
5b49b848-cf34-4024-9399-c342d71b09b6
Ewbank, Frederick G.
c5b6e441-c552-4d1a-bfc3-d1c5695e24c7
Hempenstall, Jonathan
dcad8e46-abee-46b0-98f5-bd8cd9de0b64
Sadek, Ahmed Ramadan
745c319c-82b0-4eb4-b8ea-48ea7be1f2fa
Gould, Anthony E.R.
90895709-bde6-4c80-b0f4-bb248d58cebc
Bulters, Diederik O.
d6f9644a-a32f-45d8-b5ed-be54486ec21d
Akarca, Danyal
d0cdcb85-5e96-4ed6-861c-d28ac0844f80
Durnford, Andrew J.
5b49b848-cf34-4024-9399-c342d71b09b6
Ewbank, Frederick G.
c5b6e441-c552-4d1a-bfc3-d1c5695e24c7
Hempenstall, Jonathan
dcad8e46-abee-46b0-98f5-bd8cd9de0b64
Sadek, Ahmed Ramadan
745c319c-82b0-4eb4-b8ea-48ea7be1f2fa
Gould, Anthony E.R.
90895709-bde6-4c80-b0f4-bb248d58cebc
Bulters, Diederik O.
d6f9644a-a32f-45d8-b5ed-be54486ec21d

Akarca, Danyal, Durnford, Andrew J., Ewbank, Frederick G., Hempenstall, Jonathan, Sadek, Ahmed Ramadan, Gould, Anthony E.R. and Bulters, Diederik O. (2018) An evaluation of commonly used external ventricular drain securement methods in a porcine model: Recommendations to improve practice. World Neurosurgery, 110, e197-e202. (doi:10.1016/j.wneu.2017.10.138).

Record type: Article

Abstract

Background: 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.

Methods: 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.

Results: 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 were found to be the least secure, whereas multiple sutures and hard flanges were the most secure.

Conclusions: An anchoring suture followed by a coil of the catheter and finally a flange is the most secure method for securing EVDs. This simple technique can withstand up to 8.2 times the force of a single anchoring suture, is easily used, and decreases the likelihood of EVD dislodgement and associated complications.

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More information

Accepted/In Press date: 24 October 2017
e-pub ahead of print date: 2 November 2017
Published date: 1 February 2018
Keywords: Cerebrospinal fluid, External ventricular drain, Securement, Technique, Ventriculitis

Identifiers

Local EPrints ID: 417829
URI: https://eprints.soton.ac.uk/id/eprint/417829
ISSN: 1878-8750
PURE UUID: d88c294f-2d8a-4a0b-9ea8-640ddadf3fbf

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Date deposited: 15 Feb 2018 17:30
Last modified: 15 Feb 2018 17:30

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Contributors

Author: Danyal Akarca
Author: Andrew J. Durnford
Author: Frederick G. Ewbank
Author: Jonathan Hempenstall
Author: Ahmed Ramadan Sadek
Author: Anthony E.R. Gould
Author: Diederik O. Bulters

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