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Updated: Apr 25, 2026
Insertion, Maintenance, and Removal of the Percutaneous Dual Lumen Cannula Right Ventricular Assist Device
Published on: July 20, 2022
Ventricular access device infection rate: a retrospective study and review of the literature
Jason K Chu1, Samir Sarda, Kristina Falkenstrom
1Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
Insights
Ventricular access devices (VADs) for posthemorrhagic hydrocephalus in preterm infants have a 7.0-8.0% infection rate. Close monitoring is crucial for early detection of complications, with most infants eventually needing permanent CSF diversion.
Area of Science:
- Pediatric Neurosurgery
- Neonatal Care
- Infectious Disease Management
Background:
- Ventricular access devices (VADs) are critical for managing posthemorrhagic hydrocephalus (PHH) in preterm infants.
- Reported VAD infection rates vary significantly, ranging from 0% to 22% in existing literature.
Purpose of the Study:
- To determine the incidence of VAD-associated infections at a single institution.
- To evaluate the rate of VAD to shunt conversion in patients with PHH.
Main Methods:
- Retrospective review of patients who received VADs between May 2009 and October 2013.
- Infection defined by CSF-positive cultures or wound complications; VAD to shunt conversion also recorded.
- Pooled data from 15 published studies to calculate overall infection and conversion rates.
Main Results:
- 142 VADs were placed, with 13 infections (9.2%), including 11 CSF-positive cultures (7.7%).
- 113 patients (83.1%) underwent VAD to shunt conversion.
- Pooled analysis yielded an overall VAD infection rate of 7.0% and conversion rate of 79%.
Conclusions:
- VADs are valuable for PHH treatment but carry a significant infection risk (7.0-8.0%).
- Early detection of VAD complications through close follow-up is essential.
- Approximately 80% of PHH patients require permanent cerebrospinal fluid diversion.
Purpose:
Ventricular access devices (VAD) are often used for treatment of posthemorrhagic hydrocephalus (PHH) in preterm infants. The reported rates of infection have varied and range from 0 to 22 %. The objective of our study is to present our VAD associated infection at our institution.
Methods:
The charts for patients that had VADs inserted between May 1, 2009 and October 31, 2013 at a single institution (Children's Healthcare of Atlanta) were retrospectively reviewed. The number of VAD infections, defined as either cerebrospinal fluid (CSF)-positive cultures or wound complication, was recorded. Of patients that survived, the number of VAD to shunt conversions was also examined. The data from 15 previously published studies were pooled to determine overall VAD infection and VAD to shunt conversion rates.
Results:
A total of 142 VADs were placed. There were 13 infections (9.2 %), 11 of which had CSF-positive cultures (7.7 %). There were two wound complications with negative CSF cultures. Six patients died after VAD placement for reasons unrelated to their VAD surgeries (4.2 %). In the remaining patients, there were 113 VAD to shunt conversions (83.1 %). Fifteen studies that reported VAD infections were analyzed; an overall infection rate of 7.0 % and VAD to shunt conversion rate of 79 % were calculated.
Conclusions:
While VAD is a valuable tool to treat PHH, it remains a procedure with an infection rate between 7.0 and 8.0 %. Close follow-up is needed to capture these adverse events as early as possible. Approximately 80 % of patients with PHH will require permanent CSF diversion.
