by EVDs provide drainage of CSF in conditions where normal flow and absorption of CSF is disrupted. They are often used as a temporary treatment to relieve elevated intracranial pressure until the underlying condition is corrected.
EVD Placement and Procedure
EVDs are usually placed by a neurosurgeon in the operating room using sterile technique. The patient is given general anesthesia to keep them comfortably asleep and still during the procedure. Global External Ventricular Drain A burr hole is drilled into the skull and the catheter is advanced through it into the ventricle. The catheter is then secured to the scalp with sutures or ties. It is connected to a closed drainage system that collects the fluid into a bag or chamber. The whole procedure takes around 30-45 minutes.
Post-Placement Care and Monitoring
After the catheter is placed, the patient will remain in the neuro ICU for close monitoring. Nurses will routinely measure and record CSF drainage amounts and monitor for changes in intracranial pressure. They will also watch for signs of infection or catheter malfunction. Neuro checks will be performed daily to assess changes in the patient’s neurological status. The catheter site will be kept clean and dry. Dressings may need to be changed every 1-2 days depending on drainage.
Potential Complications
While generally quite safe, EVD placement does carry some risks. Infection is one of the most serious potential complications as foreign material is introduced into the brain. Other risks may include hemorrhage, malposition of the catheter, or blockages from clots. There is also a small chance of the catheter becoming dislodged. Close monitoring helps detect any issues early. Most complications are minimized with proper sterile technique during placement and careful maintenance of the catheter system.
Global Use of External Ventricular Drain Industry
EVDs have been used for decades as a standard treatment worldwide for management of difficult hydrocephalus cases as well as acute conditions with elevated ICP like intracerebral hemorrhage, cerebral edema, and traumatic brain injury. Their availability has allowed for non-invasive diversion of CSF in many resource-limited settings that may lack advanced neurosurgical capabilities. With proper training, EVD placement can often be successfully performed even in basic operating rooms or field hospitals.
EVD Technology Advancements
EVD catheter and drainage system technology has advanced significantly in recent years. New low-profile catheters cause less tissue disruption during insertion. Antimicrobial impregnated materials and advanced connectors have reduced infection risks. New generation infection detection devices allow for continuous CSF monitoring. Catheters with adjustable pressure valves are being tested to maintain more precise ICP control. Miniaturized ultrasound-compatible EVDs now enable placement guidance without radiation exposure. These innovations have improved outcomes and expanded the reach of EVD therapy around the world.
EVD Training Programs
Several global neurosurgery groups have initiated training programs focused on safe EVD techniques for resource-limited settings. Workshops are held to teach fundamental catheter placement skills using low-cost mannequin models. Indications, procedural steps, and post-operative care are reviewed. Emphasis is placed on prevention of complications like hemorrhage and infection. Trainees practice sterile techniques and knot-tying under supervision. Online modules complement hands-on sessions. Competency assessments ensure technical proficiency before independent procedures. These programs have helped establish EVD treatment capacity in underserved areas lacking specialists.
Remote Monitoring Technology Advancements
With the growing availability of low-cost smartphones and wireless networks even in remote regions, new EVD systems with remote monitoring functions are being developed. Miniaturized devices can interface with catheter drainage chambers and transmit CSF pressure, volume, and chemical data via cellular networks. AI-assisted analytics identify abnormal trends needing attention. Video call connections between patients and specialists enable remote assessments. Some trials are exploring fully implanted EVD systems with rechargeable sensors. These evolving technologies promise to expand monitoring access and help manage patients over greater distances.
EVD Use During Global Health Emergencies
EVDs have proven invaluable during disease outbreaks and humanitarian crises requiring surge critical care capacity. Their versatility makes them well-suited for field hospitals and isolation units with limited staff and infrastructure. Prior neurosurgery training investments paid dividends when Ebola epidemics overwhelmed West African healthcare systems in 2014-16. NGOs quickly deployed trained teams who safely placed hundreds of catheters to treat viral hemorrhagic fever patients. Similar life-saving roles were filled during the COVID-19 pandemic surge by recruiting neurosurgeons to overwhelmed ICUs worldwide. EVDs will continue providing a mainstay treatment option in all contexts requiring expanded critical care access.
In summary, external ventricular drains provide an important nonsurgical option for draining excessive CSF in patients with hydrocephalus and elevated ICP from various acute conditions. Advancing EVD technology alongside training and monitoring innovations are expanding global access to lifesaving treatment even in resource-limited environments. With further progress, EVD therapy promises to grow in reach and effectiveness at managing complex neurological emergencies around the world.
*Note:
1.Source: Coherent Market Insights, Public sources, Desk research
2.We have leveraged AI tools to mine information and compile it
