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

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.