Prevention and Care of Infection Associated with Ventricular Drainage

Introduction

External ventricular drainage (EVD) is a common neurosurgery procedure in which the front end of the drainage tube is placed in the ventricle after ventricular puncture through the skull or during open circuit surgery to drain the effusion in the ventricle out of the body. It is mainly used to treat ventricular hemorrhage, hydrocephalus and other intracranial diseases, especially acute obstructive hydrocephalus, intracerebral hemorrhage into the ventricle, ventricular hemorrhage and other neurosurgical emergencies. It plays an important role in relieving brain hernia, draining blood and reducing intracranial pressure for patients. However, since the ventricular drainage tube is connected to the outside world, intracranial infection may occur. Once intracranial infection occurs, it will seriously prolong the patient's hospitalization time, increase the patient's hospitalization expenses, and even increase the patient's mortality and disability rate.

What are the related factors of ventricular drainage infection?

1. Type and device of drainage tube

Currently, EVD drainage tubes are mostly made of silicone rubber materials in clinical practice. Its soft texture, good elasticity, good biocompatibility, no irritation and allergic reaction and other advantages make it widely used in clinical practice. Many clinical studies have pointed out that the new EVD drainage bottle drainage greatly reduces EVD-related intracranial infection compared with the direct drainage of the traditional EVD drainage bag.

2. Time of drainage tube placement

A large amount of research data shows that if the retention time after catheterization is more than 10 days in clinical practice, the risk of catheter infection increases significantly.

3. Number of cerebrospinal fluid test sampling during drainage tube retention

Generally, after EVD retention, routine tests are performed 2 to 3 times a week on average, and sometimes even more. A prospective study on EVD-related infection factors conducted by 21 neurosurgery institutions in the UK and Ireland showed that too frequent cerebrospinal fluid sampling will have a very high risk of infection. Therefore, under the premise of ensuring treatment, the number of sampling should be reduced as much as possible.

4. Cerebrospinal fluid leakage

CEF leakage after EVD surgery may cause retrograde pathogens and cause infection.

5. Patient's own factors

Studies have shown that patients with older age (>60 years old) and combined with underlying diseases will also increase the risk of infection.

How to prevent ventricular drainage-related infection?

1. EVD surgery and related

Skin preparation in the surgical area, strict scalp disinfection, and minimize the surgical wound as much as possible; strict aseptic operation during the operation; the postoperative drainage tube and scalp are very important to be fixed and sealed, and the wound and drainage tube interface are wrapped with sterile dressings and properly fixed; when changing the drainage bottle or sampling cerebrospinal fluid in the ICU or bedside, the maximum sterile barrier must be made, and the operator must wear sterile surgical gowns and sterile gloves.

2. Fixation and daily maintenance of drainage tubes and drainage bottles

Fix drainage tubes and drainage bottles properly to maintain continuous drainage, observe and record the color, quality and quantity of drainage fluid; regularly maintain the puncture site and interface of the drainage tube. If conditions permit, disinfect and replace the sterile dressings at the above two sites every 3 days.

3. Prophylactic use of antibiotics is not recommended

Research data show that conventional continuous use of antibiotics has no clear effect on reducing EVD-related infections, but will increase the emergence of drug-resistant strains. Therefore, antibiotics are generally used only in the perioperative period (preoperative and 24-48 hours after surgery) in clinical practice.

4. Cerebrospinal fluid leakage

Common cerebrospinal fluid leakage after surgery may cause retrograde pathogens and lead to intracranial infection, and the longer the leakage time, the greater the chance of infection. Therefore, it is crucial to prevent cerebrospinal fluid leakage as much as possible during surgery to prevent infection.

5. Training and assessment

Standardized training of relevant professional knowledge and skills for clinical nurses, and regular assessment. Clinical research data show that good and standardized care can effectively reduce the chance of EVD-related infection.

6. Nutritional support

Strengthen the patient's own nutrition and enhance the body's resistance.

Nursing for ventricular extraventricular drainage-related infection

1. Strict aseptic operation

Performing strict aseptic operation is the top priority. Follow the aseptic principle before operation, wear a mask, hat, and hand hygiene. Cooperate with the doctor to do each cerebrospinal fluid sampling operation.

2. Close observation, basic care

During the entire treatment process, closely observe the patient's vital signs, pupil and consciousness changes. Do a good job of basic care for patients, such as oral and skin cleaning care, and keep the bed unit dry and tidy. For critically ill patients who cannot eat, nasogastric nutrition can be given to maintain adequate energy and electrolyte balance and enhance the body's resistance.

3. Pay attention to the patient's body temperature

Pay attention to the patient's body temperature at any time. If high temperature occurs, cooling treatment should be given in time. Such as drug cooling, ice bag cooling, alcohol bath, ice blanket cooling, etc.

4. Observe and record the properties of cerebrospinal fluid

Observe and record the color, volume and properties of cerebrospinal fluid. Normal cerebrospinal fluid is colorless, transparent and has no precipitation. It is slightly bloody 1 to 2 days after surgery and slowly turns orange-yellow in the later stage. If the cerebrospinal fluid is turbid and accompanied by ground glass or flocs inside, it indicates that the patient may be infected. The patient may have systemic and local clinical symptoms of infection.

5. Proper fixation

Properly fix the external ventricular drainage tube and drainage bottle to ensure that the drainage is not compressed, folded or twisted, keep the drainage unobstructed and prevent contamination. Inform the patient of the importance of the head catheter and avoid pulling the drainage tube when turning over. Restraint can be performed for more irritable patients, and sedation treatment can be given if necessary. Raise the head of the bed when conditions permit, and raise the height of the drainage bottle accordingly. When transferring patients, be sure to clamp the drainage tube and fix it properly before transferring.

6. Appropriate height

According to the doctor's requirements, the height of the drainage bottle should be reasonably hung. If it is too low, it may cause drainage too fast, which may lead to a sharp drop in intracranial pressure, thereby causing brain herniation or intraventricular hemorrhage; if it is too high, it will hinder the normal drainage of cerebrospinal fluid and cannot effectively reduce intracranial pressure.

7. Remove the catheter as soon as possible

The catheter should not be placed for too long. Generally, 7 days is appropriate in clinical practice. The nurse should inform the doctor in advance of the number of days the catheter has been in place, and cooperate with the doctor to clamp the catheter before removal, and observe whether the patient has vomiting, headache and other complications after clamping the catheter.

8. Family education

Family members who accompany the patient should also be trained in relevant infection prevention and related health knowledge, control the number of accompanying people, and minimize the entry and exit of ward personnel.

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