External Ventricular Drain Placement, Management And Nursing Care: What The Guidelines Recommend?

Abstract

Insertion of an external ventricular drain (EVD) is arguably one of the most common and most important lifesaving procedures encountered in the neurologic intensive care unit. However the most common complication of EVD is that of EVD-related infection. EVD-related infections increase morbidity, mortality, length of hospital stay, and costs; require prolonged courses of antibiotics; and increase the need for subsequent permanent cerebrospinal fluid (CSF) diversion using an internalized shunt system, such as a ventriculoperitoneal shunt. Because of this reason guides for EVD management have been established. In general, in these guides; the environment in which the catheter is placed, aseptic technique and skin preparation, catheter selection, prophylactic antibiotics, use of protocol, frequency of CSF sampling, catheterization duration and exchange, venous thromboembolism (VTE) prophylaxis, dressing type and changes and EVD care. Nurses involved in caring for patients with EVD must be knowledgeable and should ensure that the care given is based on the best available evidence. In this review; external ventricular drain placement, management and nursing care has been handled in line with the recommendations of the guides, and current approaches have been presented.

Keywords

• External ventricular drain,nursing care,guideline recommendations

Eksternal Ventriküler Drenaj Takılması, Yönetimi ve Hemşirelik Bakımı: Rehberler Ne Diyor?

Öz

Eksternal ventriküler drenaj (EVD) takılması, nöroşirürji yoğun bakım ünitesinde karşılaşılan en yaygın ve en önemli hayat kurtarıcı prosedürlerden biridir. Bununla birlikte EVD ile ilişkili enfeksiyon en sık görülen EVD komplikasyonudur. EVD ile ilişkili enfeksiyonlar; morbidite, mortalite, hastanede kalış süresi ve maliyeti arttırır, uzun süreli antibiyotik kullanımı gerektirir ve ventriküloperitoneal şant gibi kalıcı beyin omurilik sıvısı (BOS) drenajı ihtiyacını arttırır. Bu nedenle EVD yönetimi için rehberler oluşturulmuştur. Genel olarak bu rehberlerde; EVD kateter takıldığı ortam, aseptik teknik ve cilt hazırlığı, kateter seçimi, profilaktik antibiyotik kullanımı, protokol kullanımı, BOS örnekleme sıklığı, kateterizasyon süresi ve değişimi, venöz tromboemboli (VTE) profilaksisi, pansuman tipi ve değişimi ve EVD bakımı ile ilgili öneriler yer almaktadır. EVD’li hastalara bakım veren hemşireler yeterli bilgi düzeyine sahip olmalı ve verilen bakımın mevcut en iyi kanıtlara dayanmasını sağlamalıdır. Bu derlemede; EVD takılması, yönetimi ve hemşirelik bakımı rehberlerin önerileri doğrultusunda ele alınarak güncel yaklaşımlar sunulmuştur.

Anahtar Kelimeler

• Eksternal ventriküler drenaj,hemşirelik bakımı,rehber önerileri

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