Doc ID: Title: Lumbar Spinal Drainage Catheters

Effective Date: 1/22/19

Revision # Prepared By: Pisini, Boyd, Brown

Next Review Date:

Revision Date:9/2018

Approved By: Eric Brown Date Approved:

Spectrum HCP Divisional Departmental

Policy/Procedure Guideline Protocol Visual Aid

Policy:To provide guidelines for the placement of lumbar spinal drainage cathetersScope:Maine Medical Center

Definitions:None

Protocol:

Patient Selection:

A spinal drainage catheter is used primarily for one of two reasons:

Placed preoperatively to decrease the chance of spinal cord injury (due to ischemia) in open and endovascular thoracic aneurysm surgery, at request of vascular surgeon, to allow for rapid brain relaxation via CSF drainage in cranial cases, or to allow tumor manipulation for transphenoidal pituitary surgery

Placed postoperatively in cases of a chronic CSF leak after cranial or higher thoracic spine surgery, at request from neurosurgeon

There can be 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}

CHG Tegaderm

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2.0 silk ties Orange Intrathecal Stickers If tunneling spinal drain (potential need for prolonged spinal drain > 7 days):

additional Integra 14-gauge Tuohy needle, surgical blade #11, lidocaine HCL 1% 5ml and Steri-strip 1/4 in x 3 in. Follow guidelines for Tunneled Epidural Catheter

Placement

Midline, shallow angle approach. Pre-lubricate catheter with saline (using black luer lock adaptor) 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 and Taping of a Spinal Drainage Catheter after Placement

Place the 1” piece of white tubing (from package with adapters) over the end of the catheter prior to inserting the white luer adapter.

Secure the white luer adapter and catheter with 2-0 silk ties and pull the white tubing piece over the silk ties and the end of the adapter.

Dress with Mastisol, Biopatch, Tegaderm 4 in x 4 3/4 in, frame with 2 in paper tape (recommend taping catheter off to flank)

Daily Management

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

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. Please see ICP and Neuromonitoring Tools at MMC.

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 troubleshooting the catheter if technical difficulties arise

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Removal

Equipment: (will need 4-0 Vicryl Rapide, med 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 repeating above bedrest

and abdominal binder Check anticoagulation status and medications prior to removing catheter.

References

1. A nursing document, with guidelines on management of a spinal drainage catheter, including guidelines for drainage, pressure management, and general care. Click below

2. Link to a PowerPoint/pdf presentation describing indications, placement, and post-op complications of Lumbar Spinal Drainage Catheters. Click below

3. Guidelines for Tunneled Epidural Catheter, J Pisini, May 2014, MMC, Department of Anesthesiology and Pain Management (APMS)

Keywords:None

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