Lumbar Drains

Elevated ICP is a contraindication for a lumbar puncture.

Lumbar Puncture

• Kits are kept in central supply

• Lumbar drain placement is a sterile procedure

• Puncture sites in adults are generally between L3-L4 or L4-L5

• Punctures are general done to collect CSF

Indications:• CSF analysis• Treatment of hydrocephalus

caused by CSF Fistulas and Pseudotumor cerebri

• Delivery of medications or contrast into the subarachnoid space– Not usually seen on our unit

• Placement of a subarachnoid drain

Lumbar Puncture/Drain• Prior to placement, complete

a neuro assessment and vitals• Position patient in decubitus

(knee to chest) position or seated on the side of the bed leaning on a bedside table

• Blood present indicates a traumatic tap

• Apply an absorbent occlusive dressing that is assessed at least every 8 hours

Lumbar Drain Reportable Conditions• Respiratory depression• Changes in Level of

Conciousness• Pupil changes• Motor/sensory changes• Vital sign changes• Bowel/bladder

dysfunction• Headache• Persistent bleeding at the

site

Monitoring Lumbar Drains after a Lumbar Puncture

• Checks post-placement– Q15 min neuro checks and vital signs

for 1 hour; Q30 min neuro checks and vital sign 2 times; then Q1 hr neuro checks and vital for 4 hours; then as ordered for the duration of the drain placement

• Hourly drainage is usually ordered as 10mLs but should not exceed 20mLs

• Watch for precipitates because it can cause catheter occlusion

• If placed as a trail, video recording should be completed of patient walking every day

• Never have the patient move while the drain is open

Lumbar Drain Trials for Normal Pressure Hydrocephalus

Normal Pressure Hydrocephalous• Accumulation of CSF

generally in older adults that causes ventricles of the brain to enlarge

• Causes – Injury – Brain infection– No reason at all

Symptoms

• Gait disturbances– Mild instability to inability to

stand or walk• Dementia

– Loss of interest in daily activities, forgetfulness, difficulty dealing with routine tasks, and short-term memory loss

• Urinary incontinence– Urinary frequency and urgency in

mild cases, whereas a complete loss of bladder control can occur in more severe cases

Maintenance of a Lumbar Drain from the Competency

• Every hour assess and document the color, clarity, and volume of the 8-10ml of CSF and the patency of the system

• Every 2 hours perform a comprehensive neurological and vital sign assessment and compare to baseline values.

• Notify the physician if the patient experiences changes in the level of consciousness, neuro deficits, and/or a headache

• Limit patient mobility, and report inability of the patient to follow the safety instructions to the physician.

• Prevent dislodgement of the lumbar catheter through repeated explanation, sedation/analgesia or, as a last resort, the use of mechanical restraints.

• Every 4 hours perform a complete head to toe assessment of the patient.

• Assess the lumbar catheter insertion site. • Ensure the dressing covers the catheter

tubing and that no kinks are present. • Reinforce the dressing when loose. If

soiled call the physician.• Maintain the integrity and sterility of the

closed system by keeping all connections tight.

• Do not secure drainage tubing to the bed as this may dislodge the catheter if the patient moves abruptly.

• Do not allow tubing to rest under the patient when he or she is side lying because it may impede CSF flow when drain is open.

CSF Specimen Collection from a Lumbar Drain

• Obtain the sample using aseptic technique from the port closest to the patient.

• Perform hand hygiene. Don sterile gloves, mask, and cap.

• Swab the puncture port or stopcock on tubing with antimicrobial agent for three minutes (betadine, NOT Chlorahexadine) and allow drying (a minimum drying time of 3 minutes is recommended for iodine solutions).

• Swab the puncture port or stopcock on tubing with antimicrobial agent for three minutes (betadine, NOT Chlorahexadine) and allow drying (a minimum drying time of 3 minutes is recommended for iodine solutions).

• Document the procedure.

Changing the Drainage Bagfor a Lumbar Drain

• Perform hand hygiene. Don sterile gloves, mask, and cap.

• Turn the stopcock closest to the bag, off to the patient to prevent the flow of CSF.

• Disconnect the bag from the system; clean the disconnection site with an iodine swab for three minutes.

• Cap the full bag to prevent leakage and discard it as hazardous waste.

• Maintain aseptic technique. Connect the new sterile drainage bag with just enough pressure to secure but not enough to break connector.

• Ensure that the stopcocks are in the correct position for drainage.

After the Lumbar Drain is Removed2 weeks after discharge, the patient will follow up with the Neurosurgeon and if

improvements are made, a peritoneal ventricular shunt will be placed.

Question: If a lumbar drain is placed for an NPH trail, how often and how much should you drain off?

8-10mLs every hour