Instruction and safety tips
- Do not continue pulling out abdominal catheter if there is resistance!
- Once distal catheter delivered, trim it and connect it to EVD drainage system
- Set EVD at 0cm H₂O level to shunt exit site (you have externalised distal end so patient still has valve in proximally)
- Can cause necrosis of bowel due to pulling blindly abdominal catheter
Indication
- Need to exclude proximal infection (CSF infected → remove entire shunt system, EVD + antibiotics)
- Distal end problem (CSF not being absorbed adequately)
- Pleural effusion
- Abdominal pseudo-cyst
- New intra-abdominal pathology with risk of shunt becoming infected (e.g. perforated viscus) → have to ensure CSF not already infected
Surgical tips and tricks
- Cannot palpate catheter?
- Shunt series X-rays
- On table ultrasound
- Always go below the clavicle
- Roll/pull skin away from catheter slightly, incise skin then deliver catheter (to avoid cutting catheter inadvertently)
- Pleural effusion → aspirate the effusion via distal catheter before delivering out via your incision
- Abdominal pseudocyst → aspirate gently if able
- Send pleural/pseudocyst fluid to microbiology
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