Where do you level a lumbar drain?
Where do you level a lumbar drain?
The physician determines the appropriate level of drain placement in the lumbar subarachnoid space (L2-L3, L3-L4, or L4-L5). Before placement, a local anesthetic is injected into the marked area and a spinal needle is inserted into the subarachnoid space.
What are two biggest risks of lumbar drains?
Major complications included spinal hematoma with paraplegia in 1 patient, intracranial hemorrhage in 2, meningitis in 2, arachnoiditis in 3, CSF leak requiring a blood patch in 3, bloody tap delaying the operation in 1, and a retained catheter tip in 1 patient.
What happens if too much CSF is drained?
It is possible that the puncture of the ventricle or the opening of the dura will result in an intracranial hemorrhage. It is possible that if too much CSF is removed from the ventricles, either during a drainage procedure or when the ventricle is first punctured, the ventricle may collapse and occlude the catheter.
How do you fix CSF leak?
The CSF leak is repaired using your own tissue from the nose or with a biomaterial graft. Length of stay in the hospital depends on the size of the leak — most patients are in the hospital for a few days after surgery. Some patients may require a lumbar drain that is removed before going home.
How do you manage a CSF leak?
Treatments for spinal CSF leaks may include:
- Epidural blood patch. This treatment involves taking a sample of your own blood, then injecting it into the spinal canal.
- Sealant.
- Surgery.
- Trans-venous embolization.
Can a lumbar puncture drain fluid brain?
A large volume lumbar puncture is a special kind of lumbar puncture (spinal tap) specifically intended to remove 30 to 40 ml of cerebrospinal fluid (CSF) to both assess and temporarily relieve symptoms of hydrocephalus.
How long does it take for spinal fluid to build back up?
The CSF is continually produced, and all of it is replaced every six to eight hours. The fluid is eventually absorbed into the veins; it leaves the cerebrospinal spaces in a variety of locations, including spaces around the spinal roots and the cranial nerves.
How does CSF leak happen?
A CSF leak results from a hole or tear in the dura, the outermost layer of the meninges. Causes of the hole or tear can include head injury and brain or sinus surgery. CSF leaks may also occur after lumbar puncture, also called a spinal tap or spinal anesthesia.
How much CSF do I need to drain?
The patient should receive at least mild hyperventilation when CSF is drained. Normally removal of 10 to 20 mL of CSF is very effective in reducing brain tension. Up to 50 mL can be drained if necessary.
What happens if a CSF leak is not treated?
Untreated CSF leaks can lead to life-threatening meningitis, brain infections, or stroke.
How is a lumbar drain managed?
An occlusive sterile dressing is placed over the site. One of three protocols can be used to manage a lumbar drain—draining at a specific level, draining to a specific volume, or draining at a specific pressure. (See Lumbar drain management protocols .) On a regular basis, document drainage volume, color, and clarity.
What is the role of lumbar drainage in the treatment of CSF leakage?
CSF perioperative diversion reduces the incidence of postoperative leaks. Lumbar drainage (LD) can be utilized as a prophylactic measure and/or as a first-line treatment for CSF leakage following surgery.
How many CC should a lumbar drain drain per hour?
The lumbar drain was set to the shoulder level, and patients were advised to have complete bed rest. We paid close attention and monitoring to the drain as to avoid overdrainage. The lumbar drain was set to drain 10–15 cc per hour and approximately 300–400 cc in the first 2 days.
How is a lumbar subarachnoid drain placed?
The physician determines the appropriate level of drain placement in the lumbar subarachnoid space (L2-L3, L3-L4, or L4-L5). Before placement, a local anesthetic is injected into the marked area and a spinal needle is inserted into the subarachnoid space.
