Pullout-proofing external ventricular drains

The authors describe a method of securing an external ventricular drain (EVD) to prevent dislodgement and discourage CSF leakage and infection.

The EVD is secured using a single permanent suture, creating a box stitch around the exit site attached to a modified roman sandal. Multiple knots are tied after each loop to avoid "telescoping," loosening, and pullout.

In 12 years of high-volume pediatric practice by one of the authors, only one drain has broken, and none have pulled out.

The modified roman sandal technique tightly secures EVDs against pullout. Anecdotal evidence suggests that the strength of the suture construct securing the drain is greater than that of the drain tubing itself.