ABSTRACT
Lumbar drain insertion is the procedure of placement of a small flexible catheter in the lumbar subarachnoid space to either drain cerebrospinal fluid (CSF) or to monitor CSF pressure. Anesthesia providers have limited experience in managing patients with a lumbar drain. Mismanagement of the lumbar drain can lead to catastrophe. This chapter describes the procedure briefly, as well as describing commonly encountered problems related to it and recent guidelines to manage the patients with a lumbar drain.
The most important landmark is the line joining the highest points of iliac crests (intercristine or Tuffier’s line) that corresponds to the L4/L5 interspinous space or the L4 spinous process. The subarachnoid space is approached between L2-S1 intervertebral spaces in adult patients and L4-S2 in pediatric patients to avoid injury to the spinal cord. Written informed consent must be obtained. Adequate intravenous access should be secured and appropriate monitoring should be initiated. The Lumbar drain should be inserted under aseptic conditions. Patients are placed in lateral (preferable) decubitus or sitting position with curl up position in an attempt to “open up” the vertebral spaces. The Tuohy needle is advanced slowly with the sense of tissue planes traversed until the characteristic change in resistance is felt. After confirming the free flow of CSF, the needle bevel is rotated in the cranial direction, and the catheter is advanced to 5-8 cm past the needle into the subarachnoid space. The stylet is removed from the catheter and a transparent dressing is applied.
