CSF collection

[CynthiaSICU]

When your patient has a ventriculostomy drain, what is your unit protocol for CSF collection.

I work in 2 facilities and they have different protocols.

One is to collect from the buretrol in a sterile environment and allow the sample to drain into a collection cup by gravity while stop cocks to the patient are off, but there can be some contamination of old red blood cells in the butetrol.

The other is to directly aspirate 1 cc from the nearest hub with a tb syringe...which can cause negative pressure on the brain, but a better sample. ....but 1 cc is not alot of csf and the lab may reject the sample for insufficient amount.

Of course both techniques would maintain sterile technique but I am surious to know your take on this matter.

[Elenaster]

Cynthia,

The Neuro Unit I used to work in was participating in a Cyclosporin research project with severe CHI patients and we had to collect CSF daily. Initially, we would clean the proximal port with betadine and collect CSF with a 3cc syringe after turning off the drain. Unfortunately, I think this caused too much negative pressure and sometimes you would see little chunks of brain in the tube. I do know that one cc was not enough for this study and the CSF had to be a "fresh" specimen. The stuff in the bag, even if it was brand new, could not be used.

I just started a new neuro unit this past week and I will ask them the P&P for collecting CSF and get back to you. :)

[cnrn]

One of our Neuro Surgeons prefers it to be drawn out of the ventric cylinder after it is a fresh csf sample. The other likes it taken from the closest stopcock to the head.

But as previously stated, I have seen grey matter pulled out as a result of too much negative pressure as well.

Sorry, but that can't be to healthy for the pt, so I take my samples from the csf cylinder port.

[CynthiaSICU]

thanks for your help.

[JACook1]

Our Class I hospital supports seven neurosurgeons & a neuroradiologist, we often collect CSF on our patients. After working with an infectious disease doc on a case in which we were collecting daily CSF samples, he said that it must be drawn from the closest port to the brain. He stated that you run a risk of a higher nucleated cell count if collected in the chamber. This will lead to incorrect use of antibiotics. To obtain my sample, I will close the drain for a short time (as long as the ICP does not increase beyond parameters) to let the csf collect in the ventricle. Our lab has to have at least 3cc of CSF to perform the standard tests. Using sterile technique, I will place my syringe on to my port only aspirating 1cc, I will then wait 5-10min and draw another 1cc, and so on.......I never remove the syringe from the port, maintaining a closed system. I place a sterile towel on the bed where the syringe and line are placed and clean the port before drawing the sample. Hope this helps.

Jaime A. Cook RN,BSN,CNRN