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ICU One Pager EVD V11

An external ventricular drain (EVD) is a temporary sterile system used to both measure intracranial pressure (ICP) and drain excess cerebrospinal fluid (CSF). It is typically used when ICP is increased due to conditions like hemorrhage, head trauma, or tumors. The EVD system helps maintain normal cerebral perfusion pressure by draining excess CSF to reduce ICP. The height of the EVD drainage system above the patient determines the pressure at which CSF will drain. EVD settings are adjusted to avoid rapid ICP drops while maintaining normal cerebral perfusion pressure.

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Mohamed Mahmoud
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327 views1 page

ICU One Pager EVD V11

An external ventricular drain (EVD) is a temporary sterile system used to both measure intracranial pressure (ICP) and drain excess cerebrospinal fluid (CSF). It is typically used when ICP is increased due to conditions like hemorrhage, head trauma, or tumors. The EVD system helps maintain normal cerebral perfusion pressure by draining excess CSF to reduce ICP. The height of the EVD drainage system above the patient determines the pressure at which CSF will drain. EVD settings are adjusted to avoid rapid ICP drops while maintaining normal cerebral perfusion pressure.

Uploaded by

Mohamed Mahmoud
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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EXTERNAL VENTRICULAR DRAINS by Nick Mark MD ONE onepagericu.

com Link to the


most current
@nickmmark version →
DEFINITION: The MONROE-KELLI DOCTRINE:
An EVD is a temporary closed sterile system that both
Because the volume of the skull is fixed, brain swelling,
invasively measures ICP and removes excess CSF. It is CHOOSING EVD SETTINGS:
hemorrhage, or obstructions in CSF flow (hydrocephalus)
typically used when ICP is increased (e.g., hemorrhage, The objective is to use a ventriculostomy catheter
will increase ICP. As ICP rises, perfusion will decrease:
severe head trauma, large strokes, obstructing tumors). In and the EVD system to remove excess CSF and
addition to drainage of excess CSF, ICP guided medical & 𝑪𝑷𝑷 = 𝑴𝑨𝑷 − 𝑰𝑪𝑷 maintain normal CPP, while avoiding a rapid drop
surgical interventions may reduce morbidity & mortality. Cerebral Mean in ICP, which could cause re-bleeding.
Intracranial
perfusion arterial
pressure
ICP WAVEFORM INTERPRETATION: pressure pressure The height of the drip chamber above the zero
Examining the ICP waveform and trends can provide level determines at what pressure excess CSF will
useful information about CNS perfusion & compliance. be drained. (e.g. if the EVD is set at 10cm above
SHORT TERM PATTERNS (seconds) LONGER TERM PATTERNS (minutes) CSF will drain if the ICP is greater than 10 cmH2O)
P1 – related to arterial pulse; ∝ to CPP Periodic fluctuations in ICP over time
P2 - rebound of pulse; inversely ∝ to cerebral Drip chamber
fall into three discreet patterns, called An EVD is weaned by progressively raising the
compliance (e.g. ↑P2 with ↓compliance) Lundberg waves. enables the
level and then clamping it, prior to removal.
P3 – related to dicrotic notch in arterial pulse hourly output
to be
NORMAL LUNDBERG A WAVES The tip of the Ventriculostomy catheter
P1 quantified Height of drip chamber
P2 is placed in the lateral ventricle
above the zero level
P3

Trimodal pattern with P1 > P2, P3 is seen Plateaus up to 50mmHg lasting 5-20
normally. Increased P1 may be seen with minutes; suggestive of impending
increased SBP brain herniation
INCREASED ICP P2 LUNDBERG B WAVES
P1
‘Zero’ level defined by
P3 the tragus of the ear
(at FORAMEN OF MAGENDIE)
Pressure
Rhythmic Spikes in ICP every 30-120 transducer
A trimodal pattern with P2 > P1, P3 suggests seconds suggestive of cerebral
abnormal CNS compliance usually due to vasospasm
increased ICP
LUNDBERG C WAVES
MARKEDLY INCREASED ICP Proximal port is used to sample CSF
(for signs of infection, malignancy) or
to instill medication (antibiotics,
thrombolytic, etc)
Low amplitude Oscillations in ICP

v1.1 (2020-08-30)
ICP (CM H2O)
ICP (CM H2O)

every 7-15 seconds that represent


Loss of discreet waves is seen with normal CNS homeostasis. NORMAL CSF PRODUCTION = 25 ml/hr
markedly abnormal CNS compliance
Collecting NORMAL ICP = 10-15 cmH2O
TIME (SECONDS) TIME (MINUTES) bag

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