Expert Opinion on the Management of Intracerebroventricular (ICV) Drug Delivery
26 April 2017 (online)
Background: The intracerebroventricular (ICV) route of administration has been used for many decades to treat pediatric and adult patients with a broad range of central nervous system (CNS) disorders. There is no consensus in management of ICV devices and associated rates of reported complications are highly variable. A systematic literature review revealed that noninfectious complication rates per patient range from 1 to 33%, while infectious complication rates range from 0 to 27%.
Objectives: Seven health care professionals (neurosurgeons, neurooncologists, pediatricians, nurse practitioners) with expertise in ICV delivery met to discuss best practices in the management of ICV devices and drug administration and to provide guidance on prevention of complications.
Results: Experts share common practices in the management of ICV devices. Most are experienced in delivering drugs through a bolus injection, though one center has had clinical trial experience with an infusion. In either case, extreme care must be taken to follow strict aseptic/sterile techniques. Waiting a minimum of 5 days after device implantation before first use of device is recommended to allow proper wound healing and to reduce risk of backflow of the administered drug through the catheter tract. Experts differ in practice of hair removal over the device, on the type of skin prep solution used, and in use of gown and cap. All experts recommend use of sterile gloves and mask as well as skin disinfection with multiple separate swabs.
Conclusion: ICV drug delivery is an effective way to deliver drugs into the CNS when stringent measures are taken to prevent complications.