Infecção relacionada à derivação ventricular externa em hospital de neurocirurgia / Infección relacionada con derivación ventricular externa en hospital de neurocirugía / Infection related to the external ventricular shunt in a neurosurgery hospital

Objective: Identify the factors co-responsible for infection related to external ventricular shunt (EVS). Method: This is a retrospective study with quantitative data analysis developed at the Medical Archive Service of a public hospital which is a reference in neurosurgery in Pernambuco, Brazil. The sample consisted of 140 patients who underwent the insertion of external ventricular shunt. Data were collected through a semi-structured questionnaire and analyzed using the software Statistical Package for the Social Sciences (SPSS), version 13.0. Results: Predominance of males (39.7%); age between 20 and 39 years (52%); length of hospital stay over 60 days (72.7%); multiple EVS placed (100%); length of EVS use over 30 days (96.2%). Conclusion: Statistical significance for the factors: prolonged length of hospital stay; number of EVS placed; length of EVS use; and the development of infection. Nursing actions are emerging and they're aimed at ensuring patient safety in the hospital environment

Objetivo: Identificar os fatores corresponsáveis de infecção relacionada à derivação ventricular externa (DVE). Método: Trata-se de estudo retrospectivo com análise quantitativa dos dados desenvolvido no Serviço de Arquivo Médico de um hospital público que é referência em neurocirurgia em Pernambuco. A amostra foi constituída por 140 pacientes submetidos a inserção de derivação ventricular externa. Os dados foram coletados por meio de um questionário semiestruturado e analisados com o programa Statistical Package for the Social Sciences (SPSS), versão 13.0. Resultados: Predominância do sexo masculino (39,7%); idade entre 20 e 39 anos (52%); tempo de internamento acima de 60 dias (72,7%); múltiplas DVEs colocadas (100%); tempo de uso da DVE acima de 30 dias (96,2%). Conclusão: Significância estatística para os fatores: tempo de internação prolongado; número de DVEs colocadas; tempo de uso da DVE; e o desenvolvimento de infecção. As ações de enfermagem são emergentes e visam a garantir a segurança do paciente no ambiente hospitalar

Objetivo: Identificar los factores co-responsables de infección relacionada con la derivación ventricular externa (DVE). Método: Esto es un estudio retrospectivo con análisis cuantitativo de datos desarrollado en el Servicio de Archivo Médico de un hospital público que es referencia en neurocirugía en Pernambuco, Brasil. La muestra consistió de 140 pacientes que se sometieron a inserción de una derivación ventricular externa. Los datos fueron recogidos por medio de un cuestionario semi-estructurado y analizados con el programa Statistical Package for the Social Sciences (SPSS), versión 13.0. Resultados: Predominio del sexo masculino (39,7%); edad entre 20 y 39 años (52%); tiempo de hospitalización mayor que 60 días (72,7%); múltiples DVEs colocadas (100%); tiempo de utilización de la DVE mayor que 30 días (96,2%). Conclusión: Significancia estadística para los factores: tiempo prolongado de hospitalización; número de DVEs colocadas; tiempo de utilización de la DVE; y el desarrollo de infección. Las acciones de enfermería están surgiendo y tienen el fin de garantizar la seguridad del paciente en el entorno hospitalario

Cerebrospinal fluid collection: a comparison of different collection sites on the external ventricular drain.

BACKGROUND: Intracranial pressure monitoring using an external ventricular drainage (EVD) system is the most commonly used technology to monitor intracranial pressure or drain cerebrospinal fluid (CSF) in neurological and neurosurgical patients. CSF samples are collected routinely from the EVD system for laboratory tests. No study has been conducted to identify where the most appropriate site for CSF collection is in order to reduce the disruption of the closed EVD system and reduce the risk of infection. PURPOSE: The purpose of this study was to identify a CSF sampling port in the EVD system that is easily accessible, provides accurate results, and minimizes disruption to the closed EVD system. SAMPLE: Fifty patients admitted to the neurological and neurosurgical intensive care step-down unit with the EVD system between July 2007 and September 2009 agreed to participate in the study. There were 21 women and 29 men. Forty-seven patients' data were analyzed. METHOD: The design was quasi-experimental using a convenience sample. Two samples of CSF were collected daily. One sample was collected from the proximal port and another sample was collected from the distal port. The second sample was collected immediately after the first. Each set of samples (proximal and distal) was tested and compared for any differences in appearance, culture results, and concentrations of protein, glucose, and white cell count. RESULTS: Using a two-tailed paired t test with 95% confidence interval, there was no statistically significant difference between the samples obtained from the two collection sites for protein, glucose, white cell count, appearance, and culture. Pearson's correlation coefficient was also used to analyze the correlation for the continuous measures. Both protein and glucose had very high correlations. However, the white cell count, and white cell counts and culture had very low correlations. CONCLUSION: The distal port of the EVD system is safe and easy for CSF collection. It also provides accurate results for CSF samples. When the CSF sample is collected from the distal port, the entire volume of CSF in the drip chamber should be collected and tested to obtain an accurate WBC count per unit of volume.

Ventricular reservoir punctures performed by nurses: an improvement in quality of care.

Management strategies in the treatment of infants with posthemorrhagic ventricular dilation include the placement of a ventricular reservoir. Traditionally, ventricular punctures of these reservoirs have been performed only by physicians. In the pilot project described in this article, we taught nursing staff to perform punctures of a cerebral ventricular reservoir in neonates with hydrocephalus to give nurses more control in their daily care of these infants.All consecutive punctures performed between August 2006 and March 2007 (n = 302) were studied. The chart was reviewed for the infant's state during the puncture, the caregiver who performed the puncture, and the timeliness of the puncture with respect to schedule and to infant state. During the day shift, there was no significant difference in timeliness, whether the puncture was performed by a physician, a nurse, a physician assistant (PA), or a nurse under the supervision of a physician. On the night shift, punctures were performed on schedule significantly more often when they were carried out by nurses (p>.001). This pilot project demonstrated that nurses can learn to perform cerebrospinal fluid removal from a ventricular reservoir. Because it increased the timeliness with which punctures were performed and gave nurses more control in planning rest periods for these infants, this policy change was judged a success.

Normal pressure hydrocephalus.

Normal pressure hydrocephalus (NPH) is a neurological disorder characterized by a triad of symptoms: gait disturbance, dementia, and urinary incontinence. To date, the treatment of choice is cerebrospinal fluid diversion with a shunt. Because the clinical presentation of NPH mimics other neurological disorders, or can be perceived by healthcare providers as a natural aging process, it can be misdiagnosed or go undetected for many years. Patients with NPH suffer from debilitating physiological impairments as well as psychological disturbances. There are many different healthcare concerns in this population, including quality-of-life and safety issues. To achieve a more expedient diagnosis and treatment plan, nurses must be educated about this disorder.

Care and management of the child with shunted hydrocephalus.

This article reviews the physiology of cerebrospinal fluid formation and flow, the causes of hydrocephalus in the pediatric patient, symptoms of increased intracranial pressure, recent advances in shunt technology, the medical and surgical management of hydrocephalus, and potential complications of ventricular shunting devices. Nursing care in the post-operative period and for the child with shunt malfunction is discussed, as well as the long-term management needs and anticipatory guidance issues as related to a child with a ventricular shunting device. A case study of an infant with hydrocephalus illustrates key concepts.

Monitorización y medición de la presión intracraneal / Intracranial pressure monitoring and measurement

Cada día es más frecuente que las enfermeras se encuentren conpacientes con drenajes ventriculares, intraparenquimatosos y subduralespara la medición de la presión intracraneal (PIC) en áreasque no son de vigilancia intensiva o incluso en unidades no especializadasde neurocirugía. Esto hace necesaria una actualizaciónde los conocimientos de los profesionales enfermeros sobre el manejoy control de estos dispositivos.En este artículo se hace una breve revisión de la fisiología de lapresión intracraneal, se describen las características de los distintosdispositivos de medición de la PIC, la técnica adecuada para la medicióny los cuidados de Enfermería necesarios para prestar unaatención integral y de calidad a estos pacientes

It is more and more frequent for nurses to have to care for patientswith ventricular, intraparenchymatous and subduraldrainage lines for the measurement of intracranial pressure in areasthat are not part of the ICU or even in units that are not specialisedin neurosurgery. This makes it necessary to update theknowledge of nursing professionals on the management and controlof these devices.This paper presents a brief review of the physiology of intracranialpressure, describing the characteristics of the different devices forthe measurement of intracranial pressure, the appropriate techniquefor the measurement, and the necessary nursing care toprovide an integral quality care to those patients

Hydrocephalus and shunts in children with brain tumors.

Children with brain tumors are at risk for developing hydrocephalus necessitating placement of a permanent shunt catheter. As comprehensive, interdisciplinary, multispecialty care is required for these patients, the pediatric oncology nurse must become knowledgeable about caring for children with a shunt. This article focuses on the care of the pediatric neuro-oncology patient requiring shunting for hydrocephalus, including a review of cerebrospinal fluid flow and hydrocephalus, determinants of shunt placement, complications of ventriculoperitoneal shunts, and nursing considerations.

Understanding external ventricular drainage.

An understanding of the ventricular system and cerebrospinal fluid production is essential to providing appropriate care to the patient undergoing external ventricular drainage. A brief operative procedure introducing an external ventricular drain is a valuable treatment for increased intracranial pressure; however, its value must not obscure the associated risk of infection. Critical nursing care associated with successful patient outcomes includes both comprehensive neurological assessments and appropriate external ventricular drainage system maintenance.

Effects of a nursing education intervention on parents' knowledge of hydrocephalus and shunts.

The purpose of this nursing intervention study, which used a pre- and posttest design, was to determine the effect of an education program on parents' knowledge of hydrocephalus and shunt dynamics in a sample of parents of children with hydrocephalus. Study participants were parents of hydrocephalic children treated with an initial shunt or a shunt revision. The convenience sample of 41 subjects was divided into two groups (A or B). Group A participants were parents whose child received an initial shunt. Group B participants were parents whose child was admitted for a shunt revision. The shunt education intervention had three components: a shunt handbook, a preoperative teaching session with the clinical nurse specialist and a subsequent reinforcement teaching session. The pre- and posttest were the same seven multiple choice questions on hydrocephalus and shunts. In both groups, the pretest was given before the shunt education intervention. The posttest was given 2-3 weeks after the patient's surgery. There was a statistically significant change in the scores from the pre- and posttests for Group A (p = 0.0092). The nursing education appeared to have a positive effect upon this group's knowledge of hydrocephalus and shunts.

Nursing care of the child with external ventricular drainage.

External ventricular drainage (EVD) is used in children who have hydrocephalus, usually for shunt infection. Several complications, including increased intracranial pressure, hemorrhage, brain injury and infection, can occur in children with EVD. Nursing care for these children involves interventions to prevent complications and promote the well-being of children and their families.

Safe transportation for infants with severe hydrocephalus.

Attention must be devoted to proper positioning and selection of an appropriate child restraint system for infants with severe hydrocephalus to reduce the risk of potential injury during motor vehicle travel. Due to the infant's head size, parents may fear the head and neck will fall forward, or they may encounter difficulty positioning the head forward-facing in a child safety seat. Two case studies illustrate how a commercially available infant-only care seat can be modified to accommodate the infant with severe hydrocephalus and how use of a car bed restraint can meet positioning needs of these infants.

Shunt lengthening: a descriptive review.

Shunt lengthening is a neurosurgical procedure unique to the pediatric patient. It is considered to be a minor operation to the professional, but means another hospitalization to parents of children who have often times already had many hospitalizations. A review of 27 children who underwent routine shunt lengthening revealed that none developed the most common complication of infection following this operation. After questioning parents about their need for information on shunt lengthening, a fact sheet explaining the procedure was written. As a result of our findings and need to be more cost efficient while safely caring for patients, we have been successful in changing nursing management of these children.

The treatment of children with shunt infections: extraventricular drainage system care.

The history of shunt placement in children with hydrocephalus spans several decades. The current use of ventriculoperitoneal shunting has provided the most successful form of treatment. Infections, however, continue to be a major problem in as many as 30% of these patients. The use of extraventricular drainage systems (EVD) in conjunction with antibiotic therapy has proven safe and effective in managing children with shunt infections and offers many advantages compared to other forms of treatment used in the past.