Yesterday, Today & Tomorrow: Best Practice for CSF Sampling of an EVD to Minimise Patient Risk


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Australasian Journal of Neuroscience

Australian Association of Neuroscience Nursing

Subject: Nursing


ISSN: 1032-335X
eISSN: 2208-6781





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VOLUME 25 , ISSUE 2 (October 2015) > List of articles

Yesterday, Today & Tomorrow: Best Practice for CSF Sampling of an EVD to Minimise Patient Risk

Ruby Crane * / Nicole King

Keywords : External ventricular drain, cerebrospinal fluid, ventriculitis, sampling.

Citation Information : Australasian Journal of Neuroscience. Volume 25, Issue 2, Pages 7-11, DOI:

License : (CC BY-NC-ND 4.0)

Published Online: 10-January-2018



Managing raised intracranial pressure (ICP) with the use of an external ventricular drain (EVD) is a common occurrence in a neurosurgical setting. A central role of the neuroscience nurse in managing that EVD is to monitor the patient for signs and symptoms of infection otherwise known as ventriculitis. Cerebrospinal fluid (CSF) sampling from an EVD has historically been completed as a daily routine specimen to monitor for any signs of infection. However, in more recent times there has been evidence to suggest that specimens should only be collected when infection or ventriculitis is suspected to minimise the interruption of the closed system. Different practices have been identified
related to the frequency of sampling, the best solution for decontamination of the sampling site/port and preferable port for obtaining the specimen. Our aim was to complete an integrative literature review. Medline Complete and CINAHL were searched and articles were screened. Nine articles were used to form the integrated review. The main findings were collated and found that daily sampling is no longer recommended. The proximal port was the most popular choice for sampling. Decontaminating solutions used for accessing an EVD varied with no evidence to support the choice of solution. Findings of the majority of papers were focussed on sampling frequency and other associated ways to minimise infection rather than choice of sampling site or the use of specific decontaminating solutions.

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  1. Hoefnagel, D., Dammers, R., Ter Laak-Poort, M., & Avezaat, C. (2008). Risk factors for infections related to external ventricular drainage. Acta Neurochirurgica, 150(3), 209-214. doi:10.1007/s00701-007-1458-9
  2. Kitchen, W., Singh, N., Hulme, S., Galea, J., Patel, H., & King, A. (2011). External ventricular drain infection: improved technique can reduce infection rates. British Journal Of Neurosurgery, 25(5), 632-635. doi:10.3109/02688697.2011.578770
  3. Korinek, A., Reina, M., Boch, A., Rivera, A., De Bels, D., & Puybasset, L. (2005). Prevention of external ventricular drain--related ventriculitis. Acta Neu rochirurgica, 147(1), 39-45.
  4. Lwin, S., Low, S., Choy, D., Yeo, T., & Chou, N. (2012). External ventricular drain infections: successful implementation of strategies to reduce infection rate. Singapore Medical Journal, 53(4), 255-259.
  5. Muttaiyah, S., Ritchie, S., Upton, A., & Roberts, S.(2008). Clinical parameters do not predict infection in patients with external ventricular drains: a retrospective observational study of daily cere brospinal fluid analysis. Journal Of Medical Microbiology, 57(Pt 2), 207-209. doi:10.1099/jmm.0.47518-0
  6. Pfisterer, W., Mühlbauer, M., Czech, T., & Reinprecht, A. (2003). Early diagnosis of external ventricular drainage infection: results of a prospective study. Journal Of Neurology, Neurosurgery, And Psychiatry, 74(7), 929-932.
  7. Williamson, R., Phillips-Bute, B., McDonagh, D., Gray, M., Zomorodi, A., Olson, D., & ... James, M.(2014). Predictors of extraventricular drainassociated bacterial ventriculitis. Journal Of Critical Care, 29(1), 77-82. doi:10.1016/j.jcrc.2013.08.012
  8. Williams, T., Leslie, G., Dobb, G., Roberts, B., & Van Heerden, P. (2011). Reducing frequency of CSF sampling from  extraventricular drains (EVD). Australian Critical Care, 24(1), 53-54.
  9. Wong, F. (2011). Cerebrospinal fluid collection: a com parison of different collection sites on the external ventricular drain.  Dynamics (Pembroke, Ont.), 22(3), 19-24.