Intraoperative Lumbar Drain: Leaving Needle in Free

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Let's discuss an alternative method for placement of intraoperative lumbar drain. At times, placement of the lumbar drain using a large-bore Tuohy needle, such as a 14-gauge one, may not be possible as the regular lumbar drain catheter may not be threaded into the thecal sac without any significant resistance. In this situation, I use a smaller-bore lumbar puncture needle, such as a 16 or 18-gauge needle because the needle is of a smaller caliber, I'm able to penetrate the thecal sac more efficiently and effectively. And instead of passing a lumbar drain catheter through the needle into the thecal sac, I leave the needle in place and connect an IV tubing to the bore of the needle and then connect the IV tubing to the lumbar drainage bag. Obviously the patient has to remain in the lateral position during the procedure, the needle is left in place during the entire procedure and there's no need to place any catheter into the thecal sac. This method is quite effective and actually quite efficient for placement of a lumbar drain during the entire procedure and cannot be used during the postoperative period. However, fixation of the hub to the area of the back is quite important so that the needle is not inadvertently pushed into the spine. Therefore, I placed two large blankets that are folded over on both sides of the needle and placement of these bulky blankets will prevent any dislocation of the needle. I placed tape around the area of the blankets, the catheter is threaded between the two blankets and lumbar drainage can proceed as usual during the procedure and the needle is removed at the end of the surgery. Thank you.

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