Ventricular Catheter Location and the Clearance of Intraventricular Hemorrhage

Jennifer Jaffe, Eric Melnychuk, John Muschelli, Wendy Ziai, Timothy Morgan, Daniel F. Hanley, Issam A. Awad
2012 Neurosurgery  
Background-There is no consensus regarding optimal position of external ventricular drain (EVD) with regard to clearance of intraventricular hemorrhage (IVH). Objective-To assess the hypothesis that EVD laterality may influence the clearance of blood from the ventricular system, with and without administration of thrombolytic agent. Methods-The EVD location was assessed in 100 patients in two CLEAR Phase II trials assessing the safety, and dose optimization of thrombolysis through the EVD to
more » ... elerate the clearance of obstructive IVH. Laterality of catheter was correlated with clearance rates. Results-Clearance of IVH over the first 3 days was significantly greater when thrombolytic was administered as compared to placebo, regardless of catheter laterality (p < 0.005, CI −14.0, −4.14 for contralateral EVD and CI −24.7, −5.44 for ipsilateral EVD, respectively). When thrombolytic was administered, there was a trend of more rapid clearance of total IVH through an EVD placed on the side of dominant intraventricular blood as compared to an EVD on the side with lesser blood (P = 0.09; CI −9.62, 0.69). This was not true when placebo was administered. Clearance of 3 rd and 4 th ventricular blood was unrelated to EVD laterality. Conclusion-It is possible that placement of EVD may be optimized to enhance the clearance of total IVH if lytic agents are used. Catheters on either side can clear the 3 rd and 4 th ventricles with equal efficiency.
doi:10.1227/neu.0b013e31823f6571 pmid:22067423 pmcid:PMC3719169 fatcat:g224fmyi5vb73g5ekje2mik7he