Causes, Complications, and Costs Associated with External Ventricular Drainage Catheter Obstruction

Abstract

Ventricular catheter obstructions in patients treated with external ventricular drains (EVDs) have the potential to substantially impact the cost of patient care. There is a paucity of literature that directly addresses catheter obstruction over large numbers of patients with EVDs in multiple centers. Contemporary literature was reviewed to characterize causes, complications, and costs of EVD catheter obstruction. Data from published studies of EVD complications were compiled to estimate the rate of EVD catheter replacement and quantify the correlation between catheter replacement and infection. In these studies, the average number of catheters placed per patient with an EVD was 1.26, indicating a relatively high rate of replacement. Obstructions because of thrombosis and catheter malposition were identified as frequent causes of EVD replacement. Patients who underwent replacement had a 29% rate of ventriculostomy-related infection compared with 6% in those who had no replacement. The estimated diagnostic, procedural, and material cost of EVD replacement is in the range of approximately $1300-$3200 per replacement. The diagnosis and treatment of ventricular catheter obstruction, along with associated complications, creates a substantial cost burden. Further research should focus on strategies to reduce the incidence of ventricular catheter obstruction.

Keywords: External ventricular drain; Infection; Obstruction; Ventriculostomy.