Headache Resolved After Removal of JP Drain. How did that happen?

[sideshowstarlet, BSN, RN]

This seemed like the correct forum to ask my question. Hello! I just started a new job in a bigger city, leading to a >15% raise for doing similar work to what I was doing at my smaller city surgical hospital. So super excited about that!

Although I will be working night shift at this job, new employees are orientated on day shift for the first few days so that they can become familiar with the admission/discharge process for whenever this comes up on night shift. Now for my clinical question: On my first day of orientation, I was caring for a middle-aged lady, post op day 2 from a laminectomy (don't remember the exact vertebrae numbers, but it started in the lumbar area and extended into the sacral area- so lower back). She had a JP drain, pain level was tolerable, did well with putting on her back brace, able to walk well with assistx1 and rolling walker. Had some numbness to right leg, but states the numbness was decreased compared to previous day. Right dorsal pedals pulse was normal, only had +1 non pitting edema to RLE (same as LLE), able to wiggle toes and walk well.

A few hours into the shift, the patient started having increased amounts of drainage from the JP drain, started â„… bad headache and nausea. Zofran was ineffective. No worsening of numbness. I had taken over care of the pt by this time, but I kept my preceptor looped in to what was going on with the pt. When I notified the medical dr, he ordered scopolamine patch which was effective for nausea, but headache continued. I was advised to notify surgeon about the increased amount of drainage from JP drain when he rounds (surgeon and his PA were both in surgery at the time). Kept encouraging fluids, as I thought the headache might be partially due to anesthesia side effects (pt had received quite a bit of morphine the previous night. Back pain under control for my shift). Preceptor assessed the pt with me. Pupils were normal and responsive to light; sensation was the same as it had been that morning when we first rounded on her.

When surgeon rounded, I informed him of pt's headache and heavy flow from JP drain. Surgeon ordered JP drain to be pulled out, stating that it would solve the headache. Surgeon also mentioned that there was a leak during surgery, and that was likely the cause of the heavy drainage. Pulled out the JP drain, and patient's headache improved. Pt ended up doing great for the rest of her stay and was able to be discharged before Christmas Eve like she wanted.

I tried to find information online about the patho behind what happened with the JP drain seeming to cause a headache and the headache resolving after removal of the JP drain, but I can't seem to find anything. My preceptor has never seen anything like that before, either. I don't have a lot of experience in neuro; my old hospital did few back surgeries (mainly knees, hips, hernia repairs, and thyroidectomies). Just hoping that somebody on all nurses can explain this to me or point me towards resources that would explain what happened. I'm used to JP drains staying in for longer when there is heavy drainage.

Thank you!

[brownbook]

It is not my area of expertise, but it is some what common for patients to get spinal headaches if there is leakage of spinal fluid for any reason, after any type of spinal treatment or spinal injury.

Just Google, or look in your nursing reference books, for spinal headaches.