| Lumbar Drains | |
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The Problem: These drains are catheters placed at the bedside into the lumbar subarachnoid space to remove CSF. They are placed for multiple reasons including non-obstructive hydrocephalus (e.g. following SAH). They are also placed temporarily to treat CSF leaks resulting from cranial surgery or trauma. These very small drains can become disconnected from their collection devices. If they have not been contaminated much, they can be sterilized with proviodine and reconnected. If they have been contaminated, they need to be replaced. Replacement may be done by a neuro specialist or an anesthetist. Such replacement can almost always wait til the next day. |
What We Do: There are two ways to use these things. One way is to set the device at a certain level above the patient's ear and leave the valves open. Hence any pressure within the subarachnoid space that exceeds this level (i.e. 10 cm above the head or 10 cm of H2O in pressure) will drain off. The level of the drain can then be adjusted to the desired spill over pressure. The other approach to lumbar CSF drainage is to drain a fixed amount per unit time. (i.e. remove 10 cc per hour then reclamp). Remember the brain makes about 20 cc of CSF per hour. That is really the max amount you can safely drain. The total CSF volume is about 150 cc. Over draining can lead to the formation of acute subdurals. Links: Evidence Footnotes: 1. reference |
| Authorship: Dr Valerie Taylor | Last Revised: 29 May 2002 |