External ventricular drain EVD insertion (1010)

What is an EVD?

• An EVD is a small tube, called a catheter, which is used to drain fluid off the brain. It is made up of:
• Soft tubing. 
• Drip chamber.
• Pressure scale.
• Drainage bag.

Why does my child need an EVD? 

There is a fluid in and around the brain that protects it.  It is called cerebral spinal fluid (CSF). Your child needs an EVD to drain the CSF. The EVD may be needed if:

• The CSF is infected. 
• There is a blockage that does not let the CSF drain as should.

How does an EVD work?

When there is too much CSF, the pressure in the brain gets too high. The EVD helps drain some of the CSF to keep the pressure from getting too high. If there is an infection, the EVD removes the infected fluid. The nurse can collect CSF samples from the tubing when needed. 

How is the EVD placed?

The EVD is placed in surgery. 

1. Your child will be given sleep medicine to keep them still and comfortable when it is put in.
2. Your child will receive one dose of antibiotics before the surgery. 
3. A small hole is made in the skull.
4. The tube is placed through the hole and into a ventricle or subdural space in the brain.
5. The hole is stitched or stapled closed to hold the tube in place. 
The procedure takes about 1 hour. Then, your child will spend about an hour in the recovery room. 

What problems might happen? 

• Bleeding inside the brain where the tube enters the head.
• Infection of the brain or CSF.
• Nausea, vomiting, headache.

What signs and symptoms should I report to the nurse?

• Drain falls out
• The EVD comes apart in any way
• Nausea/vomiting
• Headache
• Drainage from the surgery site
• Being very fussy
• Tubing is draped up over a bed or crib railing 
• Change in behavior or strength
• More tired than normal

What else do I need to know?

It is important to keep the EVD at a certain height. Never move your child or the EVD by yourself. Tell the nurse if your child wants to sit up, get up, or use the bathroom. 
The nurse will clamp the EVD when needed. It can be clamped for a short time a few times a day so your child can walk around or participate in therapies.

When will the EVD be removed? 

Removal of the EVD depends on the reason it was placed. 

• For a brain injury or infection. The drain is removed when brain swelling is down. The intracranial pressure (ICP) needs to be within normal limits.
• For a shunt infection. When infection is gone. This takes about 7 to 10 days of IV antibiotics. 
• For bleeding into the ventricles. When there is no blood in the CSF. There needs to be a normal amount of CSF draining every hour. 
• For an externalized shunt. When the problem in the head or the stomach is better. The doctor will talk to you about options for putting the shunt back inside the body.

How is the EVD removed?

• Before an EVD is removed, the doctor may order the drainage system to be clamped. This lets the medical team see if your child is absorbing the CSF normally without any neurological problems. If your child normally has a shunt, the EVD may not have to be clamped before removal of the EVD. 
• The EVD will be removed by your child’s doctor in surgery or at the bedside. The stitches and/or staples will be removed and the tube will be gently pulled out. The doctor will then use stitches or staples to close the opening. They will be removed at a later date.