Management of External Ventricular Drains and Related Complications: a Narrative Review

Purpose of Review: Although external ventricular drains (EVDs) are widely used, there is a lot of variability in how they are managed. This review will provide an update on the management of EVDs, based on the current evidence. Recent Findings: Bundles of care focused on aseptic techniques for EVD insertion, maintenance, and care are likely to prevent EVD-associated infections. EVD management in subarachnoid hemorrhage (SAH) found no clinical advantage to gradual weaning over rapid weaning with an intermittent drainage strategy versus a continuous strategy. Rapid weaning was associated with a shorter length of stay, lower incidence of ventriculostomy-associated infections, and EVD blockages. EVD placements done by mid-level practitioners found no significant differences in accuracy or infection rates when compared to placement by neurosurgeons which could be of value in low resource centers. Intraventricular fibrinolytics for treatment of intraventricular hemorrhage may not affect functional outcomes but hasten ventricular blood clearance and may lower mortality compared to no treatment. Summary: EVDs are indicated when CSF diversion and intracranial pressure monitoring are needed. There is variability in insertion, management, and removal of EVDs, as well as administration of intraventricular medications. More research is required to standardize EVD-related processes.