Download - Lumbar Drains
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Lumbar Drains
Elevated ICP is a contraindication for a lumbar puncture.
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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
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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
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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
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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
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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
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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.
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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.
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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.
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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.
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Question: If a lumbar drain is placed for an NPH trail, how often and how much should you drain off?
8-10mLs every hour