Sampling CSF from the External Ventricular Drain Nursing Protocol

ACTION

RATIONALE

A strict sterile technique must be adhered to at all times

To prevent cross infection

Sampling must be carried out by health care professionals who are trained and assessed to be competent in the procedure

To minimise the potential risk of
complications

Equipment:
Dressing trolley containing the following:
Sterile towels & sterile gloves
Sharps box
2x 5ml syringe
2x 25g needle
2x specimen pots pre labelled
Cleansing agent i.e. 2 % Alcoholic
Chlorhexidine solution
Lab forms pre labelled
Goggles/ visors

This is a sterile procedure and a closed system is being breached.
Pre labelling of pots and forms helps towards a methodical approach A 25g needle will help prevent leakage
from the bung.
Needless sampling is recommended by system manufacturer via red bung
attached to 3 way tap on system.

Explain the procedure to the patient / family carers and rationale for the samples if applicable

To help reduce anxiety

Sampling must be taken from the three way tap that is closest to the patient’s head on the drainage system, via the red bung

Reduces the risk of contamination whilst obtaining a fresh CSF sample Using a bung that can be left on for the
life of the system will prevent infection and provide safe closure.

Wash hands and prepare the equipment on the trolley using an aseptic technique

To optimize asepsis

Once all the equipment is opened put on the goggles (visors) and sterile gloves

Reduce the risk of infection In accordance with COSHH guidelines

Wipe the three way tap with gauze soaked in 2% alcoholic chlorhexidine solution
Double clamp..
Ensure the three way tap is closed off to the port that will be sampled.
Wipe the red Vygon bung with the gauze soaked in 2 % alcoholic chlorhexidine solution.

To prevent sampling of the residual CSF in the line

 

To prevent cross infection

With a 25g needle and a sterile 5 ml
syringe remove 2.5ml of CSF and discard the syringe into a Yellow waste bag With a fresh 5 ml syringe and needle remove, gently, over a period of 30 seconds an aspirate of 2.5ml of CSF for the sample.

When the fluid has been withdrawn place the fluid into the pre- labeled sample bottles

This is enough for the samples

 

 

 

Excessive forces should not be exerted
in withdrawing the CSF as brain tissue
may be aspirated in to the drain

Open stopcock, ensure open to chamber

A common error is not returning the
stopcock to the original position

Dispose of the sharps and syringes
safely. ALL CSF waste systems and
bags to be disposed of in yellow body
fluid containers and double bagged.

To minimise risk.
As per COSHH guidelines
As per Infection Control guidelines

Arrange with the appropriate laboratories For test to be carried out Buxton labs and Aintree use different technique to cell count, so differentials may change!
1 sample ONLY at weekends unless
urgent!

To avoid samples being left unanalyzed

Obtain results and record on the External Ventricular output chart and case notes

Intrathecal antibiotics must be given by
competent health care professional

To minimize the risks

Check the intrathecal antibiotic for:
• Correctly prescribed antibiotic
• Expiry date
• Correct dose

To ensure that the correct antibiotic is
given to the correct patient

A sterile technique must be used To reduce the risk of cross infection

Administration must be given via the red bung on the three way tap on the drainage system that is closest to the patient’s head

To ensure that the antibiotic reaches the brain
Reduce the risk of contamination

Wash hands and prepare the equipment on the trolley using an aseptic technique

To optimise asepsis

Equipment required: Dressing trolley-
Sterile towels& sterile gloves
Sharps box
Cleansing agent i.e. 2 % Alcoholic
Chlorhexidine solution
Syringe containing the prepared
antibiotic

This procedure breaches the closed
system increasing the risk of cross
infection

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