Fondazione Policlinico Universitario A. Gemelli IRCCS,, Department of Pediatric Neurosurgery, Rome, Italy.
Turk Neurosurg. 2022;32(5):819-825. doi: 10.5137/1019-5149.JTN.37155-21.1.
To investigate the current practice of neurosurgeons and their perception of complications related to the securement of external drainage (ED) to the skin.
We created a 24-points English language questionnaire on Google Forms covering the five main domains of care. The survey was distributed among members of the European Society for Pediatric Neurosurgery (ESPN) in April 2020.
The results were entirely self-reported, without any independent validation. Fifty-one neurosurgeons practising in different centres worldwide participated in this survey. Despite well-known complications and drawbacks, sutures are still the most commonly used method to secure cerebrospinal fluid (CSF) ventricular ED (49 out of 51 respondents) and spinal ED (37 out of 51) to the skin. Perception of the risk of pullout is estimated as < 1% by 25.5% of the respondents, 1-5% by 39.2%, 5-10% by 17.6% and 10% by 11.8% > . Twenty out of fifty-one respondents acknowledge that their method of securement has drawbacks, and 49% believe that it may also affect the risk of infection. Factors eventually affecting the risk of pullout are young age (62.7%), aetiology (25.5%), neurological status (90.2%), occipital exit site (37.3%), inadequate length of the subcutaneous tunnel (58%), the duration of ED (70.6%), and hospital stay in service (84.3%). 39.2% of respondents agree that the paediatric population deserves a different device or technique to secure ED to the skin. 21.6% of respondents underestimate the risk of accidental pullout. 86.3% of respondents have never read about the 'sutureless subcutaneous anchoring device'.
Complications associated with the securement method, such as the risk of pullout and infection, are most likely underestimated. More research is needed to implement effective guidelines in this field.
调查神经外科医生的实践现状及其对外科引流（ED）皮肤固定相关并发症的认知。
我们使用 Google 表单创建了一份 24 分制的英语问卷，涵盖了护理的五个主要领域。该调查于 2020 年 4 月在欧洲小儿神经外科学会（ESPN）成员中进行。
结果完全是自我报告的，没有任何独立验证。来自全球不同中心的 51 名神经外科医生参与了这项调查。尽管存在众所周知的并发症和缺点，但缝线仍然是最常用于将脑脊液（CSF）脑室 ED（51 名受访者中的 49 名）和脊髓 ED（51 名受访者中的 37 名）固定到皮肤的方法。25.5%的受访者估计拔管风险<1%，39.2%的受访者估计风险为 1-5%，17.6%的受访者估计风险为 5-10%，11.8%的受访者估计风险>10%。51 名受访者中的 20 名承认他们的固定方法有缺点，49%的受访者认为这也可能增加感染风险。最终影响拔管风险的因素是年龄（62.7%）、病因（25.5%）、神经状态（90.2%）、枕骨出口部位（37.3%）、皮下隧道长度不足（58%）、ED 持续时间（70.6%）和住院时间（84.3%）。39.2%的受访者认为儿科人群需要一种不同的设备或技术来固定 ED 皮肤。21.6%的受访者低估了意外拔管的风险。86.3%的受访者从未阅读过“无缝线皮下锚固装置”的相关内容。
与固定方法相关的并发症，如拔管和感染风险，很可能被低估了。需要进一步研究以在该领域制定有效的指南。
