Practical Protocol Development for External Ventricular Drainage Management

Purpose : This methodological study aimed to develop a practical, evidence-based protocol for External Ventricular Drainage (EVD) management, toward preventing complications, reducing morbidity and mortality, and shortening hospital stays.Methods : The study was conducted between June and October, 2023. A multidisciplinary panel—comprising eight ICU nurses with ≥5 years’ experience, three neurosurgery residents, and two methodology experts—developed a preliminary protocol. Ninety-three draft recommendations were assessed for content validity by three neurosurgeons using the Content Validity Index (CVI); items with CVI = 1.0 were retained, and others were revised or removed. Seventeen additional recommendations derived from the international guidelines were incorporated, yielding 110 items. Ten ICU nurses then evaluated the appropriateness and applicability of the RAND/UCLA Appropriateness Method (RAM). Descriptive statistics were calculated using SPSS version 27.0.Results : Of the 110 recommendations, 9 were retained without change, 16 were revised, 3 were merged, and 3 were deleted. After consolidation, the final protocol comprised 104 recommendations categorized into four phases: preoperative, intraoperative, postoperative, and removal. Recommendation strength was graded using the modified GRADE system: Class I (n = 65), IIa (n = 24), IIb (n = 13), and III (n = 2). Validity was appraised using the AGREE II instrument, with a mean overall rating of 6.3 on a 7-point scale.Conclusion : The resulting protocol provides a practical, evidence-based guideline for EVD care and may serve as a methodological reference for the development of future clinical guidelines.