<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03248739</url>
  </required_header>
  <id_info>
    <org_study_id>IRB00042079</org_study_id>
    <nct_id>NCT03248739</nct_id>
  </id_info>
  <brief_title>Comparison of EVD Catheter Diameter on Occlusion and Replacement</brief_title>
  <official_title>A Comparison of External Ventricular Drain Catheter Diameter on Occlusion and Replacement: A Randomized Trial</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Wake Forest University Health Sciences</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Wake Forest University Health Sciences</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>Yes</is_fda_regulated_device>
    <is_us_export>No</is_us_export>
  </oversight_info>
  <brief_summary>
    <textblock>
      A randomized trial comparing small versus large catheters in terms of occlusion and need for&#xD;
      replacement to confirm differential occlusion risk based on catheter size. This study will be&#xD;
      done to determine whether external ventricular drain catheter diameter has any effect on risk&#xD;
      of occlusion.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Ventriculostomy is a common neurosurgical procedure. A Nationwide Inpatient Sample (NIS)&#xD;
      database study demonstrated a significant increase in ventriculostomy utilization from&#xD;
      1988-2010, with over 35,000 hospitalizations including a procedural code for ventriculostomy&#xD;
      in 2010.&#xD;
&#xD;
      Ventriculostomy occlusion is a common complication after external ventricular drain (EVD)&#xD;
      placement. A review of published prospective and retrospective studies indicates that&#xD;
      approximately 1-7% of EVDs require replacement secondary to occlusion. Furthermore, in the&#xD;
      NIS database study of over 101,000 hospitalizations in which ventriculostomy was performed,&#xD;
      nearly 6% of patients required at least one additional ventriculostomy procedure. Studies&#xD;
      have demonstrated non-patent EVD in 19-47% of patients, however these studies did not&#xD;
      prospectively evaluate EVD occlusion as a primary endpoint, report on number of catheter&#xD;
      irrigations performed, or identify risk factors for EVD occlusion.&#xD;
&#xD;
      Recently, the investigators completed a retrospective review of a prospectively collected&#xD;
      database of patients undergoing bedside EVD placement with the primary outcome of interest&#xD;
      being catheter occlusion. This sample included 101 patients over a 1 year period. Two Codman&#xD;
      catheters were available for use (Clear Bactiseal 'large' catheter: outer diameter 3.4 mm,&#xD;
      inner diameter 1.9 mm; and Orange Bactiseal 'small' catheter: outer diameter 3 mm, inner&#xD;
      diameter 1.5 mm). The decision regarding which catheter to use was made at the time of the&#xD;
      procedure based on resident preference and availability. Both temporary occlusion (requiring&#xD;
      flushing but patency could be restored) and permanent catheter occlusion (requiring&#xD;
      replacement) were common, occurring in 41% and 19% of patients, respectively. Over 25% of&#xD;
      small catheters became occluded during the study period compared to 11% of large catheters.&#xD;
      Small catheters were associated with a 3.4 times greater odds of occlusion than the larger&#xD;
      diameter catheters on multivariable regression analysis. This study suggests that the&#xD;
      preferential use of larger diameter catheters may reduce the risk of ventriculostomy&#xD;
      occlusion and need for replacement, however the study was not randomized and catheter&#xD;
      selection may have been biased.&#xD;
&#xD;
      Recently, a smaller retrospective study of patients with intraventricular hemorrhage&#xD;
      performed by Gilard and colleagues demonstrated a lower rate of occlusion and no increased&#xD;
      risk of hemorrhage with larger bore catheters. Otherwise, there is no data in the literature&#xD;
      supporting the preferential use of catheters based on size (clinical equipoise).&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Terminated</overall_status>
  <why_stopped>
    Preliminary data did not show a difference. PI decided to terminate study.&#xD;
  </why_stopped>
  <start_date type="Actual">June 12, 2017</start_date>
  <completion_date type="Actual">November 4, 2022</completion_date>
  <primary_completion_date type="Actual">November 4, 2022</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Prevention</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Permanent catheter occlusion</measure>
    <time_frame>Up to 4 weeks</time_frame>
    <description>This is defined by a non-functioning (non-patent) EVD where patency cannot be restored through catheter manipulation or flushing.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Catheter replacement</measure>
    <time_frame>Up to 4 weeks</time_frame>
    <description>Defined by replacement of the ipsilateral EVD due to permanent occlusion, or placement of a contralateral EVD in the setting of a non-functioning ipsilateral catheter. Catheters placed contralaterally in the setting of a functioning ipsilateral catheter will not be considered replacements.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Temporary Occlusion</measure>
    <time_frame>Up to 4 weeks</time_frame>
    <description>Defined by non-functioning (non-patent) catheter requiring neurosurgeon flushing or manipulation in order to restore patency. By definition, such maneuvers must restore patency of the EVD such that it is functioning normally afterwards. Multiple temporary occlusions may be possible.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Procedure-related hemorrhage</measure>
    <time_frame>48 hours after placement.</time_frame>
    <description>Presence of new catheter-related intraparenchymal hemorrhage, subdural hematoma, or intraventricular hemorrhage on CT scan 48 hours after placement.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Symptomatic hemorrhage</measure>
    <time_frame>Up to 4 weeks</time_frame>
    <description>Presence of new neurologic deficits as a result of EVD-related hemorrhage, or resulting in need for further procedures due to new EVD-related hemorrhage (craniotomy for hematoma evacuation, ICP monitoring, etc).</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Actual">33</enrollment>
  <condition>Occlusion</condition>
  <arm_group>
    <arm_group_label>Clear Bactiseal 'large' catheter (EVD)</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>All EVDs will be placed by neurological surgeons in either the major operating suite or in an ICU setting using a previously published protocol. This protocol includes using a burr hole entry point 1 cm anterior to the coronal suture in the mid-pupillary line, prep and sterile drape, pre-procedural antibiotic administration, and tunneling the catheter to an exit site at least 5 cm from the incision. In general, physicians are instructed to first attempt distal irrigation of the drainage chamber using sterile techniques (rarely effective), followed by gentle aspiration of the proximal system and catheter if distal flushing is not effective. If these do not restore patency, a small volume of sterile saline, 3 ml or less, is flushed proximally into the catheter. Patency is checked by lowering the EVD drainage system and evaluating for spontaneous flow through the EVD.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Orange Bactiseal 'small' catheter (EVD)</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>All EVDs will be placed by neurological surgeons in either the major operating suite or in an ICU setting using a previously published protocol. This protocol includes using a burr hole entry point 1 cm anterior to the coronal suture in the mid-pupillary line, prep and sterile drape, pre-procedural antibiotic administration, and tunneling the catheter to an exit site at least 5 cm from the incision. In general, physicians are instructed to first attempt distal irrigation of the drainage chamber using sterile techniques (rarely effective), followed by gentle aspiration of the proximal system and catheter if distal flushing is not effective. If these do not restore patency, a small volume of sterile saline, 3 ml or less, is flushed proximally into the catheter. Patency is checked by lowering the EVD drainage system and evaluating for spontaneous flow through the EVD.</description>
  </arm_group>
  <intervention>
    <intervention_type>Device</intervention_type>
    <intervention_name>Clear Bactiseal 'large' catheter (EVD)</intervention_name>
    <description>Antibiotic-impregnated 'large' catheter (inner diameter 1.9 mm, outer diameter 3.4 mm)</description>
    <arm_group_label>Clear Bactiseal 'large' catheter (EVD)</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Device</intervention_type>
    <intervention_name>Orange Bactiseal 'small' catheter (EVD)</intervention_name>
    <description>Antibiotic-impregnated 'small' catheter (inner diameter 1.5 mm, outer diameter 3 mm)</description>
    <arm_group_label>Orange Bactiseal 'small' catheter (EVD)</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Adult patients (18-85 years old) with a Glasgow Coma Scale (GCS) score of 7 or higher&#xD;
             requiring frontal EVD placement.&#xD;
&#xD;
          -  Diagnoses: spontaneous subarachnoid hemorrhage, intraventricular hemorrhage,&#xD;
             intraparenchymal or cerebellar hemorrhage due to aneurysm, arteriovenous malformation,&#xD;
             arteriovenous fistula, hypertension, or idiopathic etiology.&#xD;
&#xD;
          -  Also included are patients for whom the attending neurosurgeon decides that frontal&#xD;
             EVD placement is indicated for patient treatment with planned cerebrospinal fluid&#xD;
             (CSF) drainage for 72 hours or more.&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  GCS of 6 or less&#xD;
&#xD;
          -  Hunt and Hess subarachnoid hemorrhage grade of 5.&#xD;
&#xD;
          -  Age 86 or greater, or age 17 or less.&#xD;
&#xD;
          -  Patient cannot consent and next of kin cannot consent prior to procedure.&#xD;
&#xD;
          -  Diagnosis of traumatic brain injury, as the EVD is often clamped for extended periods&#xD;
             of time.&#xD;
&#xD;
          -  Patients anticoagulated prior to admission with warfarin, Effient, Plavix, therapeutic&#xD;
             heparin infusion, therapeutic subcutaneous lovenox, therapeutic subcutaneous arixtra,&#xD;
             or other therapeutic anticoagulant or antiplatelet agent (ASA not included).&#xD;
&#xD;
          -  Plan for EVD placement through non-frontal burr hole.&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>85 Years</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Kyle M Fargen, MD</last_name>
    <role>Principal Investigator</role>
    <affiliation>Assistant Professor, Surgery Neurosurgery</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>Wake Forest Baptist Health</name>
      <address>
        <city>Winston-Salem</city>
        <state>North Carolina</state>
        <zip>27104</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <reference>
    <citation>Rosenbaum BP, Vadera S, Kelly ML, Kshettry VR, Weil RJ. Ventriculostomy: Frequency, length of stay and in-hospital mortality in the United States of America, 1988-2010. J Clin Neurosci. 2014 Apr;21(4):623-32. doi: 10.1016/j.jocn.2013.09.001.</citation>
    <PMID>24630243</PMID>
  </reference>
  <reference>
    <citation>Abla AA, Zabramski JM, Jahnke HK, Fusco D, Nakaji P. Comparison of two antibiotic-impregnated ventricular catheters: a prospective sequential series trial. Neurosurgery. 2011 Feb;68(2):437-42; discussion 442. doi: 10.1227/NEU.0b013e3182039a14.</citation>
    <PMID>21135715</PMID>
  </reference>
  <reference>
    <citation>Tse Ts, Cheng K, Wong K, Pang K, Wong C. Ventriculostomy and Infection: A 4-year-review in a local hospital. Surg Neurol Int. 2010 Sep 9;1:47. doi: 10.4103/2152-7806.69033.</citation>
    <PMID>20975968</PMID>
  </reference>
  <reference>
    <citation>Bauer DF, McGwin G Jr, Melton SM, George RL, Markert JM. The relationship between INR and development of hemorrhage with placement of ventriculostomy. J Trauma. 2011 May;70(5):1112-7. doi: 10.1097/TA.0b013e3181e7c2ae.</citation>
    <PMID>20805772</PMID>
  </reference>
  <reference>
    <citation>Fichtner J, Guresir E, Seifert V, Raabe A. Efficacy of silver-bearing external ventricular drainage catheters: a retrospective analysis. J Neurosurg. 2010 Apr;112(4):840-6. doi: 10.3171/2009.8.JNS091297.</citation>
    <PMID>19764827</PMID>
  </reference>
  <reference>
    <citation>Kakarla UK, Kim LJ, Chang SW, Theodore N, Spetzler RF. Safety and accuracy of bedside external ventricular drain placement. Neurosurgery. 2008 Jul;63(1 Suppl 1):ONS162-6; discussion ONS166-7. doi: 10.1227/01.neu.0000335031.23521.d0.</citation>
    <PMID>18728595</PMID>
  </reference>
  <reference>
    <citation>Khanna RK, Rosenblum ML, Rock JP, Malik GM. Prolonged external ventricular drainage with percutaneous long-tunnel ventriculostomies. J Neurosurg. 1995 Nov;83(5):791-4. doi: 10.3171/jns.1995.83.5.0791.</citation>
    <PMID>7472544</PMID>
  </reference>
  <reference>
    <citation>Bogdahn U, Lau W, Hassel W, Gunreben G, Mertens HG, Brawanski A. Continuous-pressure controlled, external ventricular drainage for treatment of acute hydrocephalus--evaluation of risk factors. Neurosurgery. 1992 Nov;31(5):898-903; discussion 903-4. doi: 10.1227/00006123-199211000-00011.</citation>
    <PMID>1436414</PMID>
  </reference>
  <reference>
    <citation>Olson DM, Zomorodi M, Britz GW, Zomorodi AR, Amato A, Graffagnino C. Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage. J Neurosurg. 2013 Oct;119(4):974-80. doi: 10.3171/2013.6.JNS122403. Epub 2013 Aug 20.</citation>
    <PMID>23957382</PMID>
  </reference>
  <reference>
    <citation>Chi H, Chang KY, Chang HC, Chiu NC, Huang FY. Infections associated with indwelling ventriculostomy catheters in a teaching hospital. Int J Infect Dis. 2010 Mar;14(3):e216-9. doi: 10.1016/j.ijid.2009.04.006. Epub 2009 Jul 31.</citation>
    <PMID>19647466</PMID>
  </reference>
  <reference>
    <citation>Gilard V, Djoubairou BO, Lepetit A, Metayer T, Gakuba C, Gourio C, Derey S, Proust F, Emery E, Gaberel T. Small versus Large Catheters for Ventriculostomy in the Management of Intraventricular Hemorrhage. World Neurosurg. 2017 Jan;97:117-122. doi: 10.1016/j.wneu.2016.09.105. Epub 2016 Oct 10.</citation>
    <PMID>27729301</PMID>
  </reference>
  <reference>
    <citation>Rahman M, Whiting JH, Fauerbach LL, Archibald L, Friedman WA. Reducing ventriculostomy-related infections to near zero: the eliminating ventriculostomy infection study. Jt Comm J Qual Patient Saf. 2012 Oct;38(10):459-64. doi: 10.1016/s1553-7250(12)38061-6.</citation>
    <PMID>23130392</PMID>
  </reference>
  <verification_date>October 2022</verification_date>
  <study_first_submitted>August 4, 2017</study_first_submitted>
  <study_first_submitted_qc>August 9, 2017</study_first_submitted_qc>
  <study_first_posted type="Actual">August 14, 2017</study_first_posted>
  <last_update_submitted>August 2, 2023</last_update_submitted>
  <last_update_submitted_qc>August 2, 2023</last_update_submitted_qc>
  <last_update_posted type="Actual">August 7, 2023</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <keyword>Catheter</keyword>
  <keyword>Ventricular</keyword>
  <keyword>External Ventricular Drain Catheter</keyword>
  <keyword>EVD Catheter</keyword>
  <keyword>Occlusion</keyword>
  <keyword>Ventriculostomy</keyword>
  <keyword>Clear Bactiseal catheter</keyword>
  <keyword>Orange Bactiseal catheter</keyword>
  <keyword>Ventriculostomy Occlusion</keyword>
  <keyword>Neurosurgery</keyword>
  <provided_document_section>
    <provided_document>
      <document_type>Informed Consent Form</document_type>
      <document_has_protocol>No</document_has_protocol>
      <document_has_icf>Yes</document_has_icf>
      <document_has_sap>No</document_has_sap>
      <document_date>September 12, 2022</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/39/NCT03248739/ICF_000.pdf</document_url>
    </provided_document>
  </provided_document_section>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03248739
org study id: IRB00042079
nct id: NCT03248739
lead sponsor: 
has dmc: No
is fda regulated drug: No
is fda regulated device: Yes
is us export: No
A randomized trial comparing small versus large catheters in terms of occlusion and need for
      replacement to confirm differential occlusion risk based on catheter size. This study will be
      done to determine whether external ventricular drain catheter diameter has any effect on risk
      of occlusion.
Ventriculostomy is a common neurosurgical procedure. A Nationwide Inpatient Sample (NIS)
      database study demonstrated a significant increase in ventriculostomy utilization from
      1988-2010, with over 35,000 hospitalizations including a procedural code for ventriculostomy
      in 2010.

      Ventriculostomy occlusion is a common complication after external ventricular drain (EVD)
      placement. A review of published prospective and retrospective studies indicates that
      approximately 1-7% of EVDs require replacement secondary to occlusion. Furthermore, in the
      NIS database study of over 101,000 hospitalizations in which ventriculostomy was performed,
      nearly 6% of patients required at least one additional ventriculostomy procedure. Studies
      have demonstrated non-patent EVD in 19-47% of patients, however these studies did not
      prospectively evaluate EVD occlusion as a primary endpoint, report on number of catheter
      irrigations performed, or identify risk factors for EVD occlusion.

      Recently, the investigators completed a retrospective review of a prospectively collected
      database of patients undergoing bedside EVD placement with the primary outcome of interest
      being catheter occlusion. This sample included 101 patients over a 1 year period. Two Codman
      catheters were available for use (Clear Bactiseal 'large' catheter: outer diameter 3.4 mm,
      inner diameter 1.9 mm; and Orange Bactiseal 'small' catheter: outer diameter 3 mm, inner
      diameter 1.5 mm). The decision regarding which catheter to use was made at the time of the
      procedure based on resident preference and availability. Both temporary occlusion (requiring
      flushing but patency could be restored) and permanent catheter occlusion (requiring
      replacement) were common, occurring in 41% and 19% of patients, respectively. Over 25% of
      small catheters became occluded during the study period compared to 11% of large catheters.
      Small catheters were associated with a 3.4 times greater odds of occlusion than the larger
      diameter catheters on multivariable regression analysis. This study suggests that the
      preferential use of larger diameter catheters may reduce the risk of ventriculostomy
      occlusion and need for replacement, however the study was not randomized and catheter
      selection may have been biased.

      Recently, a smaller retrospective study of patients with intraventricular hemorrhage
      performed by Gilard and colleagues demonstrated a lower rate of occlusion and no increased
      risk of hemorrhage with larger bore catheters. Otherwise, there is no data in the literature
      supporting the preferential use of catheters based on size (clinical equipoise).
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Prevention
masking: None (Open Label)
measure: Permanent catheter occlusion
time frame: Up to 4 weeks
description: This is defined by a non-functioning (non-patent) EVD where patency cannot be restored through catheter manipulation or flushing.
measure: Catheter replacement
time frame: Up to 4 weeks
description: Defined by replacement of the ipsilateral EVD due to permanent occlusion, or placement of a contralateral EVD in the setting of a non-functioning ipsilateral catheter. Catheters placed contralaterally in the setting of a functioning ipsilateral catheter will not be considered replacements.
measure: Temporary Occlusion
time frame: Up to 4 weeks
description: Defined by non-functioning (non-patent) catheter requiring neurosurgeon flushing or manipulation in order to restore patency. By definition, such maneuvers must restore patency of the EVD such that it is functioning normally afterwards. Multiple temporary occlusions may be possible.
measure: Procedure-related hemorrhage
time frame: 48 hours after placement.
description: Presence of new catheter-related intraparenchymal hemorrhage, subdural hematoma, or intraventricular hemorrhage on CT scan 48 hours after placement.
measure: Symptomatic hemorrhage
time frame: Up to 4 weeks
description: Presence of new neurologic deficits as a result of EVD-related hemorrhage, or resulting in need for further procedures due to new EVD-related hemorrhage (craniotomy for hematoma evacuation, ICP monitoring, etc).
arm group label: Clear Bactiseal 'large' catheter (EVD)
arm group type: Active Comparator
description: All EVDs will be placed by neurological surgeons in either the major operating suite or in an ICU setting using a previously published protocol. This protocol includes using a burr hole entry point 1 cm anterior to the coronal suture in the mid-pupillary line, prep and sterile drape, pre-procedural antibiotic administration, and tunneling the catheter to an exit site at least 5 cm from the incision. In general, physicians are instructed to first attempt distal irrigation of the drainage chamber using sterile techniques (rarely effective), followed by gentle aspiration of the proximal system and catheter if distal flushing is not effective. If these do not restore patency, a small volume of sterile saline, 3 ml or less, is flushed proximally into the catheter. Patency is checked by lowering the EVD drainage system and evaluating for spontaneous flow through the EVD.
arm group label: Orange Bactiseal 'small' catheter (EVD)
arm group type: Active Comparator
description: All EVDs will be placed by neurological surgeons in either the major operating suite or in an ICU setting using a previously published protocol. This protocol includes using a burr hole entry point 1 cm anterior to the coronal suture in the mid-pupillary line, prep and sterile drape, pre-procedural antibiotic administration, and tunneling the catheter to an exit site at least 5 cm from the incision. In general, physicians are instructed to first attempt distal irrigation of the drainage chamber using sterile techniques (rarely effective), followed by gentle aspiration of the proximal system and catheter if distal flushing is not effective. If these do not restore patency, a small volume of sterile saline, 3 ml or less, is flushed proximally into the catheter. Patency is checked by lowering the EVD drainage system and evaluating for spontaneous flow through the EVD.
intervention type: Device
intervention name: Clear Bactiseal 'large' catheter (EVD)
description: Antibiotic-impregnated 'large' catheter (inner diameter 1.9 mm, outer diameter 3.4 mm)
arm group label: Clear Bactiseal 'large' catheter (EVD)
intervention type: Device
intervention name: Orange Bactiseal 'small' catheter (EVD)
description: Antibiotic-impregnated 'small' catheter (inner diameter 1.5 mm, outer diameter 3 mm)
arm group label: Orange Bactiseal 'small' catheter (EVD)
criteria: 
gender: All
minimum age: 18 Years
maximum age: 85 Years
healthy volunteers: No
last name: Kyle M Fargen, MD
role: Principal Investigator
affiliation: Assistant Professor, Surgery Neurosurgery
facility: 
country: United States
citation: Rosenbaum BP, Vadera S, Kelly ML, Kshettry VR, Weil RJ. Ventriculostomy: Frequency, length of stay and in-hospital mortality in the United States of America, 1988-2010. J Clin Neurosci. 2014 Apr;21(4):623-32. doi: 10.1016/j.jocn.2013.09.001.
PMID: 24630243
citation: Abla AA, Zabramski JM, Jahnke HK, Fusco D, Nakaji P. Comparison of two antibiotic-impregnated ventricular catheters: a prospective sequential series trial. Neurosurgery. 2011 Feb;68(2):437-42; discussion 442. doi: 10.1227/NEU.0b013e3182039a14.
PMID: 21135715
citation: Tse Ts, Cheng K, Wong K, Pang K, Wong C. Ventriculostomy and Infection: A 4-year-review in a local hospital. Surg Neurol Int. 2010 Sep 9;1:47. doi: 10.4103/2152-7806.69033.
PMID: 20975968
citation: Bauer DF, McGwin G Jr, Melton SM, George RL, Markert JM. The relationship between INR and development of hemorrhage with placement of ventriculostomy. J Trauma. 2011 May;70(5):1112-7. doi: 10.1097/TA.0b013e3181e7c2ae.
PMID: 20805772
citation: Fichtner J, Guresir E, Seifert V, Raabe A. Efficacy of silver-bearing external ventricular drainage catheters: a retrospective analysis. J Neurosurg. 2010 Apr;112(4):840-6. doi: 10.3171/2009.8.JNS091297.
PMID: 19764827
citation: Kakarla UK, Kim LJ, Chang SW, Theodore N, Spetzler RF. Safety and accuracy of bedside external ventricular drain placement. Neurosurgery. 2008 Jul;63(1 Suppl 1):ONS162-6; discussion ONS166-7. doi: 10.1227/01.neu.0000335031.23521.d0.
PMID: 18728595
citation: Khanna RK, Rosenblum ML, Rock JP, Malik GM. Prolonged external ventricular drainage with percutaneous long-tunnel ventriculostomies. J Neurosurg. 1995 Nov;83(5):791-4. doi: 10.3171/jns.1995.83.5.0791.
PMID: 7472544
citation: Bogdahn U, Lau W, Hassel W, Gunreben G, Mertens HG, Brawanski A. Continuous-pressure controlled, external ventricular drainage for treatment of acute hydrocephalus--evaluation of risk factors. Neurosurgery. 1992 Nov;31(5):898-903; discussion 903-4. doi: 10.1227/00006123-199211000-00011.
PMID: 1436414
citation: Olson DM, Zomorodi M, Britz GW, Zomorodi AR, Amato A, Graffagnino C. Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage. J Neurosurg. 2013 Oct;119(4):974-80. doi: 10.3171/2013.6.JNS122403. Epub 2013 Aug 20.
PMID: 23957382
citation: Chi H, Chang KY, Chang HC, Chiu NC, Huang FY. Infections associated with indwelling ventriculostomy catheters in a teaching hospital. Int J Infect Dis. 2010 Mar;14(3):e216-9. doi: 10.1016/j.ijid.2009.04.006. Epub 2009 Jul 31.
PMID: 19647466
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