External ventricular drainage (EVD) is a medical procedure that involves inserting a catheter into the ventricles of the brain to drain excess cerebrospinal fluid (CSF) that may cause increased intracranial pressure (ICP) or hydrocephalus. EVD is usually performed in patients who have suffered from traumatic brain injury (TBI), stroke, infection, tumor, or hemorrhage. EVD can help relieve symptoms such as headache, nausea, vomiting, confusion, or coma; prevent further brain damage; and improve neurological outcomes.
As a nurse, monitoring EVD is one of your vital responsibilities. Monitoring EVD involves measuring the amount and pressure of CSF drained; checking the patency and position of the catheter; observing for signs of infection or complications; and adjusting the height of the drainage system according to the physician’s orders.
Here are some steps on how nurses can monitor EVD:
- Measure the amount and pressure of CSF drained every hour or as ordered by the physician. Record the volume of CSF drained on a flow sheet or an electronic device. The normal range of ICP is 5 to 15 mmHg; however, this may vary depending on the patient’s condition and the physician’s preference. If the ICP is too high or too low, notify the physician immediately.
- Check the patency and position of the catheter every shift or as ordered by the physician. Ensure that there are no kinks or clots in the tubing that may obstruct the flow of CSF. Ensure that the catheter tip is in the correct location within the ventricle by comparing it with the initial radiograph or computed tomography (CT) scan. If there is any doubt or discrepancy, notify the physician immediately.
- Observe for signs of infection or complications such as fever, redness, swelling, pain, leakage, bleeding, or altered mental status. Report any abnormal findings to the physician immediately.
- Change the level of the drainage system as per the doctor’s orders. The level of the drainage system controls how much CSF is drained and influences the ICP. The level of the drainage system should match a reference point on the patient’s head, such as the earlobe or the corner of the eye.
