Effect of tunnel length on infection rate in patients with external ventricular drain.

BACKGROUND External ventricular drain involves catheter placement in ventricles of brain. It is used for various purposes. Basic theme is to drain cerebrospinal fluid so as to control intracranial pressure. This study was carried out to see the effect of tunnel length on rate of infection. METHODS This was a cross-sectional study carried out in Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad during 14 months from 1st December 2008 to 31 January 2010. External ventricular drain was placed in admitted patients after meticulous aseptic technique in operation theatre at right Kocher's point. It was carried out through a scalp tunnel and was connected to drainage bag through a drip set. Both long (> 5 Cm) and short (< 5 Cm) tunnels were randomly made. Infection rate was estimated in patients who had change of cerebrospinal fluid colour or developed fever (as per protocol to have minimum handling of drain). All patients received prophylactic Ceftriaxone. RESULTS Among 76 patients long tunnel was made in 44 (57.9%) and short in 32 (42.1%). Three patients (3.9%) with long tunnel while 6 (7.9%) patients with short tunnel had infection. The overall infection was in 9 (11.8%) patients. CONCLUSION External ventricular drain tunnel length strongly influences the rate of infection.