Hydrodynamic properties of extraventricular drainage systems

OBJECTIVE: Extraventricular drains (EVDs) are intended to control intracranial pressure for patients with acute disorders of the cerebrospinal fluid circulation. We tested five commercially available EVDs to assess their fundamental hydrodynamic properties:, which determine the quality of this control. METHODS: The five most frequently used drainage systems were tested. The pressure responses to water flow from a computer-controlled infusion pump were studied in the rig constructed in the UK Shunt Evaluation Laboratory (Cambridge, England). EVDs were studied under normal conditions and after brief (20-s) contact of the vent located in the drip chamber with the test reagent. Pure water and water with 10% rat blood content were used for testin-g. RESULTS: All of the tested EVDs demonstrated low hydrodynamic resistance [<3.5 drip mm Hg/(ml/min)], indicating their ability to control intracranial pressure. When the chamber vents were in brief contact with the reagent, the hydrodynamic properties of two models were unaffected. For the three other EVDs, blockage of the drip chamber was observed, leading to increases in the inlet pressure to more than 150 mm Hg. All three models that demonstrated obstruction have the same vent configuration, which allows cerebrospinal fluid to accumulate close to the filter when the drip chamber is held horizontally. This feature was confirmed to be the cause of the blockage. CONCLUSION: In clinical practice, special care should be taken to avoid contact of the drip chamber vents with cerebrospinal fluid, which causes obstruction and may lead to the development of gross intracranial hypertension. Specific configurations, as are safer than others in this respect. identified in this testing program.