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Updated: Apr 25, 2026
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Published on: October 14, 2022
Long subcutaneous tunnelling reduces infection rates in paediatric external ventricular drains
Christian D E Collins1, John C Hartley, Aabir Chakraborty
1Southampton Medical School, University of Southampton, Southampton, UK, cc10g12@soton.ac.uk.
Insights
Long subcutaneous tunnelling of external ventricular drains (LTEVDs) significantly reduces infection and catheter displacement in children. This technique offers clinical and economic benefits compared to traditional methods.
Area of Science:
- Neurosurgery
- Paediatric Medicine
- Infectious Disease Control
Background:
- External ventricular drains (EVDs) are crucial for managing paediatric hydrocephalus and intracranial pressure.
- Infection and catheter displacement are significant complications associated with EVDs, impacting patient outcomes.
- Long subcutaneous tunnelling (LTEVD) is a technique proposed to mitigate these complications.
Purpose of the Study:
- To evaluate the efficacy of long subcutaneous tunnelling of external ventricular drains (LTEVDs) in reducing infection and catheter displacement rates.
- To assess the safety and effectiveness of LTEVDs in a paediatric population.
- To compare the outcomes of LTEVDs with published data on short-tunnelled EVDs.
Main Methods:
- A retrospective analysis of 181 LTEVD insertions in children managed under a local guideline.
- Key endpoints included new cerebrospinal fluid (CSF) infection and re-operation for catheter displacement.
- Data were compared against existing literature on short-tunnelled and long-tunnelled EVDs.
Main Results:
- The overall new infection rate for LTEVDs was 2.76% (3.8% when excluding cases with pre-existing infections).
- Catheter displacement requiring reinsertion occurred in only 2.2% of cases.
- A statistically significant reduction in infection rates was observed compared to short-tunnelled EVDs (p < 0.05).
Conclusions:
- Antibiotic-impregnated LTEVDs, managed with a defined protocol, demonstrate significantly lower infection and displacement rates.
- The LTEVD technique offers considerable clinical advantages and potential economic benefits in paediatric neurosurgery.
- This approach represents an effective strategy for improving EVD management in children.
Purpose:
The aim of this study is to report the efficacy of long subcutaneous tunnelling of external ventricular drains in reducing rates of infection and catheter displacement in a paediatric population.
Methods:
In children requiring external ventricular drainage, a long-tunnelled drain was placed and managed according to a locally agreed guideline. End points were novel CSF infection incurred during the time of drainage and re-operation to re-site displaced catheters. Data were compared to other published series.
Results:
One hundred eighty-one long-tunnelled external ventricular drains (LTEVDs) were inserted. The mean age was 6.6 years (range 0-15.5 years). Reasons for insertion included intraventricular haemorrhage (47 %), infection (27 %), tumour-related hydrocephalus (7.2 %), as a temporising measure (17 %) and trauma (2.2 %). The overall new infection rate for LTEVD was 2.76 %. If the 48 cases where LTEVDs were inserted to treat an existing infection are excluded, the infection rate was 3.8 % (5/133). The mean duration of insertion was 10 days (range 0-42 days). Four LTEVDs (2.2 %) were inadvertently dislodged, requiring reinsertion. Thirteen patients required removal of EVD alone. There was a significant difference (p < 0.05) when comparing our infection rate to 14 publications of infection rates in short-tunnelled EVDs; however, there was no difference when comparing our data to three publications using LTEVDs.
Conclusion:
The use of an antibiotic-impregnated LTEVD, managed according to a predefined guideline, is associated with significantly reduced infection and displacement rates when compared with contemporary series. It is suggested that this reduction is of both clinical and economic benefits.
