Hemorrhagic Complications Induced by External Ventricular Draining Catheters

Huh, Joon; Joo, Won Il; Chough, Chung Kee; Park, Hae Kwan; Lee, Kyung Jin; Rha, Hyoung Kyun

Abstract

BACKGROUND
External ventricular drainage (EVD) is one of the most frequently performed operative procedures in neurosurgery. A retrospective analysis was conducted for patients who underwent EVD to determine the incidence rate of post-procedural intracranial hemorrhage and to identify underlying risk factors.
METHODS
Patients who underwent EVD between January 2003 and January 2011 were selected. Catheter-induced hemorrhage (CIH) was defined as any evidence of new hemorrhage on the post-procedural computerized tomography (CT) scan obtained within 24 hours of catheter insertion. The rate of hemorrhage was calculated, and the possible risk factors were statistically analyzed.
RESULTS
The data of 229 patients were analyzed. Twenty-one patients developed CIH, for an incidence rate of 9.17%. The factors that increased the rate of CIH were age > or =60 years, bilateral catheter insertion, and pre-existing heart disease. The patients > or =60 years of age had a 2.8-fold increased risk of CIH. A history of heart disease contributed to a 20-fold increased risk of CIH (p < 0.001). Those three parameters were evaluated by multiple logistic regression analysis and patients who had all three risk factors were 18 times more likely to have CIH than patients with no factors.
CONCLUSION
CIH is a frequent complication that cannot be over looked in patients who undergo EVD insertions. Age > or =60 years, bilateral catheter insertion, and a history of heart disease are the three most significant risk factors for CIH. Since these risk factors are not modifiable, all possible contributors should be considered to minimize the risk such as skilled maneuvers and techniques or high blood pressure.