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The insertion of an external ventricular drainage (EVD), common as a lifesaving measure for patients with raised intracranial pressure, can be performed both at the pa-tient bedside and under controlled sterile conditions in the operating room. The proce-dure has been performed under sterile conditions in the operating room at the university hospital in Marburg since 2008. One of the most frequent and most dangerous compli-cations is the development of an EVD-related infection. The interplay between situa-tional factors such as the sterility of operating conditions, assistance of trained profes-sionals, optimal storage practices, the illumination available in the operating room and the infection frequency in comparison with EVD placement at the patient bedside is the central issue of the present study. In addition, we investigated further complications, such as the occurrence of intracranial bleeding and the accuracy of the EVD location.
Data on 97 patients ages 18 and up from the university hospital in Marburg with EVD placement over the period between 2005 and 2012 were retrospectively analysed for the occurrence of an EVD-related infection. We created an Excel spreadsheet containing admission diagnosis, laboratory parameters (CRP, leukocytes, PCT), cerebrospinal flu-id parameters (cell number, glucose, protein), microbiology results, and several others. According to the studies available to date, we defined the criteria for the presence of a „secure infection“, „probable infection“, „possible infection“, „excluded infection“ and „contamination“. These categories were summarized into „available infection“ and „not available infection“ for further statistical evaluation using Excel and SPSS. To provide further information, we used statistical tests such as a t test and chi-square test.
In total, 21 patients were diagnosed with an „available infection.“ Therefore, 32.4 % of patients with an EVD insertion at the patient bedside and 15 % with the procedure in the operating room suffered from an EVD-related infection. With a p value of 0.05, this is a statistically significant difference. In reference to the occurrence of EVD-related intra-cranial bleeding, there was no statistically significant increase in risk at the patient bed-side (p value 0.58). An incorrect EVD position was identified in 13 patients (15.5 %); however, a potentially life-threatening intracerebral EVD location was found with the smallest proportion twice.
This work outlines the increased occurrence of EVD-related infections in patients with EVD insertion at the patient bedside. Consequently, we recommend sterile and well-organized operating conditions in the operation room. In addition, the increased risk of intracranial bleeding at the patient bedside contributes to this decision. Nevertheless, precise EVD positioning is possible regardless of the location of the operation. We can-not confirm the necessity of an elective drainage exchange, a question much debated within diverse scientific studies, because we could not find any relevant infection fre-quency reduction. Due to the retrospective nature of the study’s data and its limited sample size, the results aren`t decisive and further research is needed.