January 07, 2016
I use the lumbar drain pretty frequently and generously, during any craniotomy, where the basal cisterns or any other large CSF cistern, are not reached early on to achieve brain decompression. Let's review the techniques for this very simple procedure. Before the patient is placed into his or her final operative position, I use the lateral position and prep the area of the lower lumbar region, drapes are used, a relatively large bore Tuohy needle 14 to 16 gauge is used to penetrate the thecal sac along the L4-5 interspace. The bevel of the needle is directed superiorly, and the interspinous space is used to penetrate the thecal sac and go through the ligaments. It's important to know that the needle has to have an angle just about the angle of the inferior spinous process, in order to be able to penetrate the subarachnoid space. The stylette is adequately positioned at the tip of the needle to avoid dragging any of the skin elements into the thecal sac. Here's the contour of the Spinous process he's followed, until the ligament is entered and a pop is felt and clear CSF is obtained, subsequently the appropriate size lumbar drain catheter was passed through the needle into the thecal sac. I avoid using the wire within the catheter as much as possible. If the catheter is passed easily, if resistance is encountered, then I use the wire. The needle is withdrawn over the catheter and the catheter is connected to its hub and the proper tubing and the drainage back. I use ample amount of all stir sponges, to avoid any kinking of the catheter doing placement of the patient in the supine position. If appropriate padding is not used to protect the catheter at its exit point at the level of the skin, the catheter can kink as it enters the skin and its lumen can be clogged and therefore the drain can be non-functional. After our proper dressings applied, the patient is placed for his or her final operative position. Thank you.
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