A ventricular drain or ventriculostomy is a brief surgical procedure carried out in the head to insert a device that drains cerebrospinal fluid (CSF) accumulation in the brain. This apparatus is mostly installed in an external location, and its deployment is either temporary or permanent.
The procedure targets the ventricles, which are a collection of cavities in the brain where CSF is stored. They are often blocked for a variety of reasons or contain an abnormally high volume of CSF, both of which contribute to an increase in intracranial pressure. The device frequently remains in place until the cranial pressure returns to normal.
Traumatic brain injury is another possible cause of intracranial pressure. As the pressure inside the head often rises quickly, causing serious and potentially irreversible damage to brain tissue, this condition is urgently considered a medical emergency. After a ventricular drain is installed, the pressure in the brain is expected to return to normal.
In other circumstances, ventriculostomy is carried out to administer medications for the treatment of brain ventricles or other brain-related issues, as well as to diagnose CSF, the presence of which often indicates the presence of infection or other underlying diseases that are the source of neurological symptoms. Patients who undergo this procedure require long-term monitoring, careful treatment alterations, and evaluation for any additional diseases that often develop.
To normalize intracranial pressure (ICP), a ventriculostomy is performed to divert CSF from the ventricular system. In this procedure, a flexible silastic catheter is inserted into the ventricle of the brain using a rigid internal stylet.
Before the procedure, the neurosurgeon meets with the patient for a pre-surgical consultation. During this time, he checks the patient’s overall physical and mental health. The patient often needs to discontinue the use of some medications before surgery, particularly those that increase the risk of bleeding or clotting.
The only anesthesia used during procedure is a local one, which is applied to the area of the scalp where the incision is made. To maximize the patient’s comfort, sedation is also often administered.
The patient remains flat on his back throughout the operation. After cleaning and shaving a section of the scalp, a surgical drape is placed over the rest of the head. The surgeon then uses a surgical drill to make a hole in the head so they access the dura mater. In certain instances, this is sufficient to reduce intracranial pressure. To continue ventricular drainage, however, a tube is placed into the ventricle and connected to a bag. Additionally, the patient is wired into a system that tracks both cerebrospinal fluid (CSF) and brain pressure.
A temporary tube is referred to as an external ventricular drain (EVD). It is known as a shunt if it is permanent. Sutures are used to secure the tube in place, while the drain remains intact.
Ventriculostomy is a procedure that allows for the drainage of cerebrospinal fluid (CSF) from the cerebral ventricles to relieve elevated intracranial pressure caused by communicating or non-communicating hydrocephalus.
To facilitate drainage, a hole (“stomy”) is made inside the cerebral ventricle during this procedure. Surgery is used to cut through the skull, the dura mater, and the brain to get to the ventricle.
Ventriculostomy Catheter Placement
The catheter is linked to a fluid-filled system that is linked to an exterior transducer. After passing through a transducer and a signal processor, the pressure reading emerges on the screen as a waveform and a numeric value. If necessary, spinal fluid is redirected from the monitor into a drainage bag via a three-way stopcock. With the transducer placed at the level of the brain’s center, which typically corresponds to the external auditory meatus, this arrangement enables the catheter to be zeroed as frequently as required.
Ventriculostomy Nursing Care
A neurologically compromised patient with a ventriculostomy benefits greatly from the assistance of nurses. The nurses taking care of patients keep an eye on the following:
- Constantly check the CSF drainage.
- Make sure the CSF oscillates inside the tubes.
- Avoid any chance of the wound getting soaked.
- Check that EVD is at the proper height.
- Intensive monitoring of the patient’s neurological condition
- Observe ICP hourly
Strict adherence to the suggested checklists is required. The pillars of the care bundle approach for managing these patients are the maintenance of a sterile environment and rigorous monitoring for anticipating and resolving complications promptly.