Turkish Neurosurgery 2022 , Vol 32 , Num 5
How to Secure CSF External Drainage to the Skin: Hints from an International Survey and the Current Literature
Carolina NOYA1,Anna Maria AURICCHIO1,Luca MASSIMI1,Federico BIANCHI1,Gianpiero TAMBURRINI1,Paolo FRASSANITO1
1Fondazione Policlinico Universitario A. Gemelli IRCCS,, Department of Pediatric Neurosurgery, Rome, Italy
2Università Cattolica del Sacro Cuore, Rome, Italy
DOI : 10.5137/1019-5149.JTN.37155-21.1 AIM: To investigate the current practice of neurosurgeons and their perception of complications related to the securement of external drainage (ED) to the skin.

MATERIAL and METHODS: We created a 24-points English language questionnaire on Google Forms covering the five main domains of care. The survey was distributed among members of the European Society for Pediatric Neurosurgery (ESPN) in April 2020.

RESULTS: The results were entirely self-reported, without any independent validation. Fifty-one neurosurgeons practising in different centres worldwide participated in this survey. Despite well-known complications and drawbacks, sutures are still the most commonly used method to secure cerebrospinal fluid (CSF) ventricular ED (49 out of 51 respondents) and spinal ED (37 out of 51) to the skin. Perception of the risk of pullout is estimated as <1% by 25.5% of the respondents, 1-5% by 39.2%, 5-10% by 17.6% and 10% by 11.8%>. Twenty out of fifty-one respondents acknowledge that their method of securement has drawbacks, and 49% believe that it may also affect the risk of infection. Factors eventually affecting the risk of pullout are young age (62.7%), aetiology (25.5%), neurological status (90.2%), occipital exit site (37.3%), inadequate length of the subcutaneous tunnel (58%), the duration of ED (70.6%), and hospital stay in service (84.3%). 39.2% of respondents agree that the paediatric population deserves a different device or technique to secure ED to the skin. 21.6% of respondents underestimate the risk of accidental pullout. 86.3% of respondents have never read about the 'sutureless subcutaneous anchoring device'.

CONCLUSION: Complications associated with the securement method, such as the risk of pullout and infection, are most likely underestimated. More research is needed to implement effective guidelines in this field. Keywords : Anchoring, External drainage, Pullout, Securement, Ventricular catheter

Corresponding author : Paolo FRASSANITO, paolo.frassanito@gmail.com