Surgical Protocol for External Ventricular：体外心室外科手术....ppt

Surgical Protocol for External Ventricular Catheter (EVD) Placement for CLEAR III TrialSurgical Coordinating Center for CLEAR IIINorthShore University HealthSystemEvanston, IllinoisRevised May 12, 2009General Principles?All EVD placements are performed under full sterile technique (cap, gown, gloves, mask, full draping), and by the most senior skilled surgeon (housestaff or attending) immediately available to perform the EVD procedure.?When more than two passes are required for EVD placement, additional stabilization of catheter site will be determined with a CT performed at 24 hours after placement before proceeding with CLEAR.?Suboptimal catheter placements are all too frequent, and are associated with less efficient IVH clearance. Hence it is important to optimize surgical techniquefor EVD placement in every case and to consider image guided insertion whenever possibleEmergent versus Image Guided Techniques of EVD Placement?Emergent EVD Placement is typically performed using the twist drill and external landmarks in the ICU or Emergency Department setting for the first catheter placement, whenever intracranial pressure (ICP) control is an issue and per the surgeon’s clinical judgment.?Image guided EVD Placement is considered for placement of the second EVD (clot producing trapped ventricles, clinically important shifts, or panventricular enlargement with effacement/ischemia-- typically with larger IVH > ), or for elective catheter replacement (infection, obstruction, malposition, unplanned migration or withdrawal of previous EVD). Emergent EVD Placement?Patient is positioned supine, with head in neutral position, and head of bed elevated slightly (20-30 degrees)?Frontal area is shaved on side of EVD placement (typically right side for first catheter or on side of predominant ventricular dilation)Emergent EVD Placement (cont.)?EVD entry point is marked cm behind the nasion, and cm from the midline?The head is taped in neutral position to minimize movemen