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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