different brand and like names for the evd available in your hand all of them they sharing the same responsibility or the same function to drain the csf you can monitor the icb this is one of them available in your institution or you might have such another brand like this one or you might have such system so for demonstration purposes we will demonstrate on this system and emphasizing that all systems sharing the same principle and component and we will start the talk from the patient side so this tube will be connected to the evd drain okay which is con inserted in the in the ventricles and the csf will be go through this tube and here we will find there is two labels yellow label to tell the practitioner that you are dealing with csf access not to be confused with um like central line boards to give the medications and so on now here we will have a stopcock three ways to cook this system we will find it a lot actually like three times in the system the main idea that this one will regulate the flow of the fluids so four boards here one of them is closed the off one is closed so if the board was like this it means the fluid cannot go through the system the main idea the three-way are open and one way is not open if we look to the hole here you can find the hole that will allow the fluids to drain and if you look at here there is a hole as well but when we put it in the offside you will find there is no hole it means the way here is closed so this one is the main stock book where we will connect it to the zero level now if our patient has lumbar drain we will connect it to the lumbar like this [Music] if my patient has a ventricular drainage we will connect that one to the ventricular and here we have another stop cook if the stove cooked like this it means the fluids can go to the system here we will go to the chamber which is transparent collector and it's graded up to 75 ml it has hydrophilic vent the chamber connected to the bag and also again a stock cook so the bag has a one way valve and also hydrophilic vents here we find a zero level the same level with the mains to cook zero level and the minister cook the level of the mainstream coke should be always in the zero and this one should be at the same level of the foramen of monroe where the lateral ventricle connected to the third ventricle in order to control the drainage from the patient side the uh the main stopcock will be at the level of the foramen of monroe for the patient and the addative here is the level of the chamber so the pressure from the patient side has to exceed this level the difference between here and here enable to the to the csf to be drained in the chamber increase the pressure level and decrease the pressure level based on the practitioner recommendation the pressure level reflected by centimeter water or millimeter mercury now if the order to maintain the pressure like 10 millimeter mercury it means the csf after reach that more than 10 it will start to drain for us so if the order is to keep the pressure 10 millimeter mercury it means i have to increase it until 10 i can see it actually from the window here so 10 millimeter mercury equal to 13.6 centimeter water and we can change if the practitioner prefer the centimeter water level we can change it to the centimeter water 10 millimeter mercury equal to 13.6 centimeter water all system has two way to fix the the evd for to the patient level by the board clamp and by the integral cord performed hand hygiene and one threaded gloves sterile gown surgical cap and mask [Music] used a two person method to prime the evd system prepare this thrill field ensure that all tubing connections remain sterile when connecting and flushing we need to connect the primary stopcock to the system based on the drain we have like lumber or ventricular now we will use the transducer we will not use the pressurized bag as there is risk that some fluids will go to the vision side we will just use the transducer itself so we need to prime it and flush it with a free bezel normal saline to make sure that there is no air bubble in the system remember once you connect to the patient you cannot flush anymore so we will connect the transducer to the main stopcock to the main system stopcock [Music] once i connect it then i need like to hang it on the stand to make sure that i will flush the system and i will flush the transducer i will start flushing to the tour division side so once i will flush the division side i will make sure that i close it from the basin side then i will flush the system once i flush the system now i will flush the transducer make sure that there is no air bubble in the system once you remove the cap use a new sterile cap instead so now we flush the transducer we are flushing the system completely close it by the cap non-vent cap now is the time to connect the transducer with the cable which connected to the monitor then we can connect it to the patient we need to make sure that the level of transducer the zero on the same level for the foramen of monroe which we are using triggers as a landmark so number zero and the transducer and the foramen of mondo are in the same level you can use laser or you can use a scale the and every time you change the position or change the patient as a side you need to do the zeroing for prescribed pressure if the order is to make it thin you will fix it until if the order is 15 you will fix it on 15 centimeter water according to the order now if there is an order to have like reading for the icb we need to close to the vessel side at the beginning okay then after that we need to make the zero in this system we will put the drainage on the zero level same level with like the drain same level with the transducer and the patient foramen of mondo the system is open between the transducer and to the drain which has a air vent antimicrobial filter then we will go to the monitor to make zero once the the monitor show me that there is zero level i need before taking the reading i need to return it back to the prescribed pressure after that i need to open between the patient and the transducer so the transducer can read the pressure from the patient side so now the patient and the transducer they are open together so the monitor can give me reading okay so it is open now from the patient to the transducer if i look to the monitor and i have to have like reading and this time we have like nine millimeter mercury as icp this system allows practitioner to drain csf or to monitor the icb the system will not allow like the practitioner to drain csf and monitor at the same time if you need like accurate results after that after i took the reading i can now open it to the patient to allow patient to drain for the dressing it should be dry clean if there is need you can change it anytime if not every 72 hours in a sterile strict manner if there is order to send for csf sample then you need to close it from the patient side few minutes unless there is contraindication we need to clean it with antiseptic solution and give it time to dry after that now it is closed from the basin side and to the drain system but it's open from the vision side and the syringe which we will use it to collect our sample when the drainage bag is about three-quarter full for this bag around 450 ml and more we need to drain the bag using needleless connector and the syringe after cleaning it with aseptic like technique or changing the bag based on your institution the important point is to maintain sterility to prevent infection