The primary reasons for inserting an EVD include unstable status, increased ICP that is difficult to stabilize, or infection from an existing VP shunt; the EVD may drain CSF intermittently or continuously according to need, but drainage and ICP monitoring are not an option unless a fiberoptic monitor is used (Pope, 1998). The EVD is a closed system made up of transparent pliable tubing, a collection bag, and, at times, a drip chamber between the tubing and the collection bag. The EVD is placed at the level of the child’s external auditory meatus with the head at a 20- to 30-degree elevation, depending on physician preference. Elevating the EVD above this level decreases the flow of CSF, and placing the device below the level of the external meatus increases the flow. Ambulation or sitting up in bed or chair usually requires that the tubing be clamped to prevent imbalance in CSF drainage. In addition, the EVD is a closed sterile system and should be handled as such in relation to emptying the device or changing the scalp dressing. Accurate and frequent documentation of the incision site; amount, color, and consistency of drainage into the device; and the child’s vital and neurologic signs are an important part of the nursing care.