Bedside vs OR Ventriculostomy: What the Kit Must Support

A bedside ventriculostomy is usually performed in the ICU or emergency department, often urgently, with a small team and no OR support, so the kit must be complete, compact and quick to set up. An OR ventriculostomy has full instrumentation and staff, and the catheter may be placed alongside another procedure. Each setting places different demands on the drainage system.

Many hospitals place external ventricular drains in both settings, and the choice depends on urgency, the patient’s condition and local practice. For a distributor, understanding the difference helps propose the right assortment for each location and avoid the common mistake of stocking the OR well while leaving the ICU short. This article compares the two settings from a device and supply point of view.

Why are so many EVDs placed at the bedside?

Acute hydrocephalus, intraventricular hemorrhage and raised intracranial pressure after trauma or subarachnoid hemorrhage can deteriorate quickly. Moving an unstable patient to the OR takes time and carries its own risks, so many neurosurgery teams place drains at the bedside in the ICU or emergency department, using a twist-drill or small burr hole technique. In teaching hospitals, residents often place these drains, particularly overnight.

Bedside placement depends on everything being available in one place. If a component is missing, the team either improvises or delays, and neither is acceptable in an emergency.

Guideline-based management of severe traumatic brain injury includes intracranial pressure monitoring and CSF drainage in appropriate patients, so trauma centers in particular expect to place drains at any hour. Their bedside readiness is something a distributor can support directly, by keeping the right kits in the right places and making sure every shift knows where they are.

When is the OR the preferred setting?

Drains are placed in the OR when the patient is already there for another procedure, such as a craniotomy, a tumor resection or the treatment of a vascular lesion, or when the surgeon prefers OR conditions for a difficult placement. Some institutions place most drains in the OR as a matter of policy. In the OR, the surgeon has full instrumentation, imaging support and staff, and the drain may be one step in a longer operation.

How do the two settings compare?

What must a bedside kit support?

For bedside placement, the drainage system and catheter should be available as a complete, ready-to-assemble set, stored with the other items needed for the procedure. Teams evaluating a system for bedside use typically ask:

• Is everything needed for drainage in one package, or will we need to collect parts from different places?
• How quickly can the collection system be assembled and mounted on the pole?
• Is the catheter easy to handle and tunnel with the limited instruments available at the bedside?
• Are standard and antibiotic-impregnated versions both available where the drain is placed?
• Is the packaging easy to open onto a sterile field without contamination?

The EVD-010 Series suits this setting because it is supplied as a configured system: a 31 cm ventricular catheter, a 30 cm measuring scale, a 150 ml drip chamber and an 800 ml drainage bag, with a standard or antibiotic-impregnated catheter. The drilling instruments and procedure tray are separate, so confirm with the hospital how its bedside cart is organized.

What does the OR need from the kit?

In the OR, flexibility often matters more than completeness. The surgeon may want to choose the catheter separately, place it during another procedure and connect the collection system at the end of the case. The ventricular catheter kit provides a radiopaque silicone catheter with tantalum length marks from 5 to 15 cm and 24 drainage holes in four rows, in standard or antibiotic-impregnated versions. It can be paired with a collection system such as the EVD-020 Series, which combines a pressure scale, drip chamber, drainage bag and filter and also works with a lumbar catheter.

OR teams also ask about the radiopacity of the catheter and the visibility of length marks, because postoperative imaging is used to confirm position. And they ask how the system will be handed over to the ICU nurses, which is why OR and ICU education should be coordinated.

How should a distributor stock both settings?

A common error is to stock the OR generously, because that is where the rep visits most often, and to leave the ICU and emergency department with too little. A location-by-location plan prevents that:

• Neuro-ICU: configured systems in both catheter versions, at a par level based on bedside placements plus a buffer.
• Emergency department: at least one complete system reachable at all times, on an expiry watch list.
• Main OR: catheter kits in both versions and collection systems, based on case volume.
• Procedure carts: a clear checklist so the drainage system is always stored with the procedure tray.

Review usage by location every quarter. If bedside placements rise, for example after a change in neurosurgical staffing, adjust ICU and emergency department par levels before a shortage occurs.

What happens at the hand-over between OR and ICU?

When a drain is placed in the OR, the patient usually travels to the ICU with the system already connected. The hand-over between the surgical team and the ICU nurse is a point where details can be lost: which catheter version was used, the ordered height, whether the drain is open or clamped, and how the system was secured for the journey.

Device choices can make that hand-over easier. Using the same collection system in the OR and the ICU means the ICU nurse receives a familiar setup. Distinct catheter versions, such as the orange antibiotic-impregnated catheter, are easy to recognize and document. Lot numbers recorded in the OR travel with the patient record. A distributor who notices friction at hand-over can suggest a simple checklist, built with the nurse educator and the OR educator, that covers the device elements while the clinical elements stay with the hospital’s protocol.

What training does each setting require?

Bedside placement involves residents, ICU nurses and sometimes emergency department staff, who all need to know where the kit is stored, how it is opened and how the collection system is assembled. OR placement involves scrub and circulating staff, who need to know the catheter options and how the system is handed over. A distributor should offer short sessions for each group and coordinate the hand-over between OR and ICU.

DESU designs and manufactures its drainage systems and catheters in Ankara, Türkiye, under ISO 13485, with CE-marked products and exports to more than 50 countries. Distributors can rely on the manufacturer for technical answers and documentation for both settings.

Talk to a DESU product specialist

If you are planning EVD stock for an account that places drains at the bedside and in the OR, DESU’s product specialists can help you choose configurations and catheter versions for each location in your market. Email sales@desu.tr or request a quote.