Akarca Danyal, Durnford Andrew J, Ewbank Frederick G, Hempenstall Jonathan, Sadek Ahmed-Ramadan, Gould Anthony E R, Bulters Diederik O
Faculty of Medicine, University of Southampton, Southampton, UK.
Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, UK.
World Neurosurg. 2018 Feb;110:e197-e202. doi: 10.1016/j.wneu.2017.10.138. Epub 2017 Nov 2.
External ventricular drain (EVD) dislodgement is common and leads to significant morbidity and mortality. Many securement techniques to prevent this are described. There are, however, no objective studies comparing them. This study aimed to determine the most secure method of securing an EVD.
A survey was distributed through the British Neurosurgical Trainee Research Collaborative to determine common EVD securement methods and select techniques for testing. Securement methods were tested in a pig cadaver model. Peak pull force before EVD failure was measured. Failure was defined as catheter displacement 1 cm from the insertion site, catheter fracture, or suture fracture.
Twenty-three neurosurgical units responded. Five basic EVD securement methods were in common use. These were tested in isolation and in combination so that in total 15 common methods were tested. The most secure method was a triple construct, consisting of an anchoring suture, sutures around a coil of the catheter, and either a soft plastic flange (25.85 N, 95% confidence interval 24.95 N-26.75 N) or a hard plastic flange (29.05 N, 95% confidence interval 25.69 N-32.41 N). Of the individual methods, single anchoring sutures, soft flanges, VentriFix, and staples were found to be the least secure, whereas multiple sutures and hard flanges were the most secure.
An anchoring suture followed by a coil of the catheter and finally a flange is the most secure method for securing EVDs. This simple technique can withstand up to 8.2 times the force of a single anchoring suture, is easily used, and decreases the likelihood of EVD dislodgement and associated complications.
脑室外引流（EVD）移位很常见，会导致严重的发病率和死亡率。人们描述了许多预防这种情况的固定技术。然而，尚无比较这些技术的客观研究。本研究旨在确定固定EVD最可靠的方法。
通过英国神经外科实习医生研究协作组织进行了一项调查，以确定常用的EVD固定方法并选择用于测试的技术。在猪尸体模型中测试固定方法。测量EVD失效前的最大拉力。失效定义为导管从插入部位移位1厘米、导管断裂或缝线断裂。
23个神经外科单位做出了回应。常用五种基本的EVD固定方法。对这些方法进行了单独和组合测试，共测试了15种常用方法。最可靠的方法是三重结构，包括一根锚定缝线、围绕导管线圈的缝线，以及一个软塑料法兰（25.85 N，95%置信区间24.95 N - 26.75 N）或一个硬塑料法兰（29.05 N，95%置信区间25.69 N - 32.41 N）。在单独的方法中，单根锚定缝线、软法兰、VentricFix和吻合钉被发现最不可靠，而多根缝线和硬法兰最可靠。
先使用锚定缝线，接着围绕导管线圈，最后使用法兰是固定EVD最可靠的方法。这种简单技术能承受单根锚定缝线8.2倍的拉力，易于使用，且降低了EVD移位及相关并发症的可能性。
