Failures that led to a young man suffering severe brain injuries after an operation have been acknowledged by medical staff at an inquest.

Firth Lord, of Martin Street, Turton Bottoms, had an external ventricular drain (EVD) fitted into his head in the early hours of November 28, 2019, after an emergency operation to treat hydrocephalus, or water on the brain.

An inquest has heard how EVDs are a temporary measure to drain fluid from the brain, relieving pressure from it.

But just after 9am Firth suffered a cardiac arrest as no fluid had been draining from his brain for some time due to one of the valves being ‘clamped’ , dying a few weeks later at Salford Royal Hospital.

Daniel Holsgrove, a consultant neurosurgeon investigated Firth’s death, told coroner Peter Sigee at Bolton Coroner’s Court he believes the valve closest to his head had been clamped at some point between Firth going from surgery recovery onto a ward at the hospital, causing fluid to dangerously build up on his brain. This should have been noticed by one of the nurses.

Fluid had been draining through the EVD after his operation with checks made hourly to see this. But after 6am fluid appeared to stop draining. Nurses believed this was not a cause for concern as the EVD was still showing signs of working normally and Firth appeared stable.

Mr Holsgrove said: “The lack of fluid draining suggests it (EVD) was clamped at that point, the amount of fluid in the brain after the cardiac arrest also suggests this ­— the finding was consistent with a clamped drain.”

The nurses gave evidence saying their training said they should not check the valve closest to his head as the EVD appeared to be oscillating (working) still.

Mr Holsgrove described this lack of draining as a “matter of concern” which should have been raised and his “expectation” would have been the valves should have been checked if there was no drainage of fluid happening. He made clear changes have been made since this incident.

Their investigation after Firth’s death found the checks being done for EVDs were not consistent throughout the patient process, with staff and nurses now subject to a new training course.

It has now been made clear to nurses the whole EVD system needs to be checked hourly, even if there appears to be oscillation, if no fluid is draining.

Mr Holsgrove, questioned by family lawyer Paul Williams, said there were “misunderstandings” about what amounted to oscillation from nurses in Firth’s case and when valves needed to be checked.

The inquest heard nurses may have “convinced themselves” the EVD was oscillating when it wasn’t.

“We accept there were failures in training given to nurses at the time,” Mr Holsgrove said.

Louise Hood,the hospital’s assistant director of nursing surgical neurosciences, added: “It was clear through our investigation that there were inconsistencies about how training was delivered. There is now a robust training package that has to be revisited regularly.

“The handover process was not as robust as we wanted it to be, with two people now required to check and sign a pathway form after it is clamped or unclamped. The whole device now needs to be checked every time there is a check now.”

The inquest has been adjourned to gather more evidence on Firth’s pre-admission care. The family has concerns that if the lymphoma had been definitively diagnosed earlier, different treatment could have been done which could have prevented hydrocephalus and the need for the EVDs, and the complications with this that led to the cardiac arrest.

Lymphoma is likely to have caused an obstruction in Firth’s brain, leading to fluid building up and hydrocephalus, Mr Holsgrove said. The inquest will resume next year.