Safe Duration for Ventricular Catheterization

Objective: The question of how long an external ventricular drain (EVD) can be safely left without increasing the incidence of infection has remained a controversial question. Several studies have been conducted, but a general consensus has not been agreed upon. We will attempt in our study to answer this question.Method: In the period from March 2007 to April 2012, fifty six patients that have underwent EVD insertion, due to various pathologies have been included in the study. Infection was defined as a positive CSF culture, as well as one of the clinical signs denoting infection, i.e. fever, nuchal rigidity, photophobia, altered mental status. A strict protocol was adopted to eliminate other risk factors that might increase the risk of infection.Results: Duration of catheterization ranged from 2 to 17 days, cerebrospinal fluid infection occurred in 11 cases, coagulase-negative staphylococci were the most common isolated organism in 7 cases, most cases of infection occurred after day 8 post-insertion of the EVD.Conclusion: From our initial results, we recommend that EVD should be removed (provided there is no further indication), or prophylactically replaced before day 8 post-insertion, so as to decrease the incidence of ventriculostomy induced infection.