Risk factors for complications in bolt-connected external ventricular drains

This study was aimed at identifying risk factors for the main complications following bolt-connected external ventricular drain (EVD) insertion.

This was a single-centre cohort study. All patients who underwent bolt-connected EVD placement between March 2015 and February 2024 were included. The complications analysed were infection, haemorrhage, misplacement, obstruction, and accidental pull-out. The need for EVD replacement was also recorded. Univariable and Cox regression multivariate analyses were performed.

A total of 119 procedures were analysed. The duration of ventriculostomy (OR 1.14; 95% CI 1.02-1.27) and the occurrence of cerebrospinal fluid leak (OR 409.86; 95% CI 1.36-12,353.36) or system obstruction (OR 31.44; 95% CI 2.04-484.85) were confirmed to be independent risk factors for infection. No risk factors were identified for misplacement or obstruction. Thicker catheters (OR 25.56; 95% CI 2.28-286.33) and antiplatelet or anticoagulant use (OR 7.29; 95% CI 1.75-30.41) were found to be independent risk factors for EVD-related haemorrhage. Men showed a 72% increased risk of accidental EVD pull-out. Finally, involuntary pull-out (OR 79.36; 95% CI 8.32-756.99), misplacement (OR 39.38; 95% CI 3.21-482.64), and obstruction (OR 31.55; 95% CI 2.70-368.40) were found to be independent risk factors for a new drain replacement.

We have confirmed the duration of ventriculostomy, cerebrospinal fluid leak, and catheter obstruction to be independent risk factors for infection. Thicker catheters and antiplatelet or anticoagulant drug use were identified as independent risk factors for EVD-related haemorrhage. Male gender increased the risk for involuntary catheter pull-out. Finally, accidental removal, obstruction, and misplacement were confirmed as independent risk factors for re-inserting a new EVD. Neither surgeon's experience nor bedside placement in the intensive care unit increased the risk.

Our study has identified the risk factors for the most common complications associated with a specific type of ventricular catheter (bolt-connected EVDs), which allows the targeting of preventive measures. This is the first study to have analysed this specific group of drains, which are increasingly being used in clinical practice.