Spinal drain post-op management 2

SPINAL DRAINS

POST-OPERATIVE MANAGEMENT

IN RECOVERY/ITU/HDU

Rachael Lear

Advanced Vascular Nurse Practitioner

CLAMP DRAIN

FOR PATIENT TRANSFER

13.5cm

Zero level

SET-UPPatient horizontal or 30 degrees head up position

Zero mark on measuring tape (attached to drip stand) is level with external meatus (mid

ear).

Position drain so that the pressure level is level with the 13.5cm mark on the measuring

tape

13.5cm

Zero level

Why is the set up important?

Normal CSF pressure is 10mmHg

13.5 cmH20 = 10mmHg

If the drain is kept at 13.5cm above the spinal cord, CSF will drain into the

chamber if the pressure rises above normal.

The Golden Rule

DO NOT MOVE THE PATIENT OR THE

CHAMBER WITHOUT CLAMPING THE DRAIN

Chamber too high

Reduced CSF drainage

Increased CSF pressure

Paraplegia

The Golden Rule

DO NOT MOVE THE PATIENT OR THE

CHAMBER WITHOUT CLAMPING THE DRAIN

Chamber too low

Excess of CSF drainage

Reduced intracranial pressure

‘Coning’ of brain/intracranial bleeding

Subdural

haematoma

caused by tearing

of the dural

bridging vein

attributed to

excessive CSF

drainage

Murakami et al. 2004

• Are all the 3-way taps covered with a bung?

• Is the drain labeled? “Spinal drain: NOT for

injection”

• Is the bed locked to prevent it from being moved

up/down?

• Do all the staff know that your patient has a

spinal drain? (including the domestics!)

• Does your patient know that they have a spinal

drain and the implications for their position in

bed/mobility?

• No warfarin/clopidogrel

• Do you know who to call if the patient develops

neurological deficit?

MONITORING: PATIENT PARAMETERS

MAP >85-90 mmHg (inotropes)

Haemoglobin >10 g/dl

PO2 7.3 – 10.6 kPa

O2 saturation >95%

Spinal cord perfusion pressure

= MAP - CSFP

MONITORING: HOURLY NEURO OBS

MONITORING: VOLUME & COLOUR OF CSF

• Measure & record the volume & colour CSF drained hourly.

• If >10mls/hour or 5-10mls for 2 consecutive hours, inform the

vascular registrar immediately.

• If CSF has not drained for a period of two consecutive

hours, nursing staff should check patency of spinal catheter.

TO CHECK CATHETER PATENCY

STRICT ASEPTIC TECHNIQUE

TO CHECK CATHETER PATENCY

Aspirate

0.5mls max

Clamp

closed to

chamber

Three-way

tap open to

the patient

Colour/clarity of CSF

Bloody CSF can indicate spinal haematoma/ intracranial haemorrhage

5% (24/486) patients with spinal drain bloody CSF

17/24 patients: CT demonstrated intracranial haemorrhage

• ITU: sedation hold every morning to check neuro status & motor

function

• Insertion site check every 12 hours for evidence of infection/CSF

leak

• Drain may be clamped briefly (<5 minutes) for care activities

• Prophylactic LMWH can be given daily

• NO INTRATHECAL INJECTIONS via spinal drain

• CPAP increases CSF pressure & may lead to paraplegia:

commencing CPAP is a consultant decision

MANAGEMENT: other important points

REMOVAL: ANTICOAGULATION

• 12 hrs after last dose of SC

clexane (up to 40mg)

Restart 4 hrs after removal.

• IV heparin infusion:

stop infusion, wait until APTR

normal, remove drain.

Restart infusion 4 hrs after

removal.

• Other: seek advice from

haematology

REMOVAL: PROCEDURE

• Check clotting/platelets/timing of last

heparin dose

• Aseptic technique

• Check complete removal by

looking for blue tip

• Apply a transparent occlusive dressing once the catheter is

removed and Inspect the insertion site every 2 hours for 24

hours, looking for CSF leak

• Neuro obs for 24hrs

• Handover timing for safe administration of anti-coagulation