External ventricular drainage (EVD), is one of the most frequently performed neurosurgical procedures, with approximately 20,000 performed annually. EVD placement is often considered a lifesaving measure to alleviate severe hydrocephalus or elevated intracranial pressure (ICP).

A major benefit of EVD placement is the ability to monitor ICP and also remove fluid with the same device.

Current guidelines recommend a staged approach to management of elevated intracranial pressure, with escalation when more conservative efforts are unsuccessful at managing elevated pressures.

The purpose of this review will be to discuss the devices themselves in regard to their clinical management and troubleshooting.

One of the major benefits of an EVD is they allow drainage of CSF as mentioned but also allow you to transduce an ICP, which enables you to more accurately assess CPP on critically ill patients.

In most models of EVD you are not able to drain CSF and transduce an ICP at the same time.

For this reason, you must clamp the EVD prior to recording an accurate ICP.

This may be confusing as even with the EVD unclamped you will still see a reading on the monitor, but this is inaccurate.

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