EVD Placement and Dressing

EVD Placement and Dressing Protocol:

• Clean hands with soap/water or alcohol solution
• Broad clipping of hair:
  • the entire top of the head
  • use both coarse and fine clippers
• Degrease skin using gauze pad saturated with isopropyl alcohol
• Give single dose of antibiotic (e.g. cefazolin) given prior to incision
  • No prophylactic antibiotics given after single pre-incision dose
• Chlorhexidine skin prep prior to draping (not iodide prep!)
• Full sterile draping of patient’s head and entire body
• Wear cap, mask, sterile gown, and sterile gloves
• All staff in room wear cap and mask
• Repeat chlorhexidine skin prep after draping
• Use rifampin / minocycline impregnated ventricular catheter (e.g. VentriClear)
• Tunnel catheter 3-5 cm from insertion site
• Dressing:
  • Catheter secured in question-mark pattern using surgical staples
  • Benzoin tincture applied to skin and allowed to fully dry by evaporation
  • Chlorhexidine-eluting patch (e.g. BioPatch) applied over catheter exit site
    • do not wrap around catheter
  • Medium-sized adherent transparent dressing film (e.g. Tegaderm)
  • Secure borders of dressing film with sterile adhesive strips (e.g. SteriStrips)
• No routine dressing changes – change for dressing compromise only:
  • If dressing change needed:
    • re-clip if needed;
    • use full sterile technique including gown, gloves, mask, hat, and draping as above;
    • re-prep with chlorhexidine

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