Maine Medical Center

Department of Anesthesiology and Pain Management
Pisini May 2014

 

guidelines for the management and removal of lumbar spinal drains

 

 

PATIENT SELECTION

       Request from neurosurgeons for CSF leaks

       Request from vascular surgeons for surgical procedures

       Ensure no contraindications to placement and no plans for anticoagulation while patient has indwelling CSF drain

 

EQUIPMENT (all located on the Block Cart in room 20)

       Epidural Anesthesia Tray

       Integra NeuroSciences External CSF Drainage Kit {includes MoniTorr ICP external CSF drainage bag system, Hermetic lumbar catheter closed tip, guidewire, 22-gauge blunt needle(black used to flush spinal catheter with saline), flexible luer adapter(white used for final connector for spinal drain) and Integra 14-gauge tuohy needle}

       Tegaderm CHG 3.5in x4.5 in

       2.0 silk ties

       Curasilk tape 1 in

       Orange Intrathecal Stickers

       If tunneling spinal drain (potential need for prolonged spinal drain > 7 days): additional Integra 14-gauge tuohy needle or 14g IV Angiocath, surgical blade #11, lidocaine HCL 1% 5ml and steri-strip ¼ in x 3 in.  Follow guidelines for Tunneled Epidural Catheter  

 

PLACEMENT

       Midline, shallow angle approach.

       Pre lubricate catheter with saline prior to placement of stylet

       Thread catheter 10-15 cm or as limited by paresthesia or resistance (markers on catheter indicate how far the catheter is in the space)

       Remove tuohy needle prior to removing stylet

       Hold and secure catheter at skin and slowly withdraw stylet

 

SECURING THE CSF DRAIN

       Secure the white luer adapter and catheter with 2.0 silk ties x 2

       Dress with mastisol, tegaderm CHG and frame with 2 in paper tape (recommend taping catheter off to flank)

       Secure connector/spinal drain with curasilk tape and add intrathecal sticker

       Instructions available on theapms.com

 

EPIC ORDER SET

       Enter orders in EPIC:  ANES Lumbar Spinal Drain

 

DAILY MANAGEMENT

       Attach the provided MoniTorr ICP external CSF drainage bag system for intra-op use only.  For intra-op monitoring, ensure that the pressure bag is not connected to the transducer while monitoring ICP.  

       Non OR patients, simply cap the end of the drain.  Nurses on R608 or CTICU/SCU will obtain the Codman drainage system from central supply

       Neurosurgeons or CT surgeons are responsible for providing orders regarding the amount and frequency of draining

       We are responsible for checking the site daily and trouble shooting the catheter if technical difficulties arise

 

REMOVAL (will need 4-0 Vicryl Rapide, medium needle holder, chloraprep, lidocaine HCL 1% 5ml, sterile gloves and suture removal kit; all located on the Block Cart in room 20) 

       Close the puncture wound with 4-0 Vicryl Rapide stitch (figure of eight)

       Recommend abdominal binder x 2days

       Recommend bedrest with HOB flat as much as possible x 2 days (may be up for meals and up to the bathroom)

       If CSF leak persists or presence of pseudomeningocele, recommend continuing bedrest and abdominal binder