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Discussion

EVD Placement

Hello,

I am a Neurosurgical NP in California. We are trying to get our standard procedures approved in our Medical Center and have met some resistance. Our Medical Center has asked us find out about community standards and standard procedures. Do any Neurosurgical NPs out there place EVDs? Which Medical Centers allow this Privilege for their APPs?Any feedback is greatly appreciated!

Thank you

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    I'm in the Bay Area and I don't know of any NP's or PA's that perform EVD placement. In our institution (large university setting) Neurosurgery residents place them and I've worked in a community-based Neuroscience ICU where attending Neurosurgeons place them. That doesn't mean that it doesn't happen. It's a skill that can be taught or learned and as in any procedure, the volume of procedures performed will make a difference in a provider's level of proficiency.

    If I were to push for this to be included in my Standardized Procedures, I would use this study as evidence: Accuracy and Safety of External Ventricular Drain Placement by Physician Assistants and Nurse Practitioners in Aneurysmal Acute Subarachnoid Hemorr... - PubMed - NCBI. I would also work on a protocol that requires the NP perform a number of EVD placements (i.e., 20 insertions) with supervision from an attending prior to having the ability to perform the procedure independently.

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    I place EVDs routinely. Every hospital in the area has NPs/PAs that do even if there are residents. Not sure why this would be a big deal. Go for it!

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