External ventriculostomy: a practical application for the acute care nurse

External ventricular drainage systems (EVDs), or external ventriculostomies, are challenging additions for the neurosurgical patient. An EVD involves a catheter placed in the ventricular space. It is used to drain off excess cerebrospinal fluid that is causing hydrocephalus and increased intracranial pressure. The cerebrospinal fluid is produced in the brain and flows through the four ventricles, to the arachnoid space around the spinal cord, then is absorbed by the arachnoid villi in the brain. The causes of hydrocephalus include tumors and hemorrhage. The nursing responsibilities include monitoring for infection, bleeding, herniation, documenting aspects of the drainage system and providing emotional support for the patient and family.