Need your input on lumbar drains

[cdibley]

Hi everyone,

So I recently oriented to lumbar drains, we really don't do very many in my CVICU. I have a question about the HOB, is it true that the patient must always remain flat and not even move their lower extremities at all? I understand that when you are actually draining this is necessary but it doesn't seem like it should be when it is clamped and only measuring. The nurses I oriented with seem so anxious whenever the patient moves and it's only monitoring the ICP and not open and draining. I would think it would be okay for the patient to assist with turns and move their legs a little as long as I am not draining anything. thoughts?

Also any tidbits on lumbar drains, I'd love to hear! TIA!

[KelRN215, BSN, RN]

Yeah, I worked pediatric neurosurgery for 5 years and we definitely didn't require our lumbar drain patients to be on strict bedrest with HOB flat. They got up and walked to the bathroom, they did PT. I once walked a 3 year old with a lumbar drain to the playroom (it was clamped for the walk) and he asked me and his father if it was pee coming out of his back. Once he sat in his chair at the little play table, the drain was leveled as ordered and opened. Definitely not necessary to remain on bedrest with HOB flat when the drain is open and draining either. There should be orders for where to level it and then the drain just needs to be re-leveled when the patient moves.

If you have questions about the drains, call Neurosurgery or the Neurosurgery floor. They deal with them all the time. A patient with a lumbar drain was only allowed to go to the ICU or to our Neurology/Neurosurgery floor when I worked in the hospital.

[EricaAngela90]

I think it depends what the lumbar drain was placed for. If it's a patient who had a csf leak after something like a tethered cord repair then they should be flat in order for the leak to heal. Eventually they start moving around but not for a few days. The neurosurgeon should have specific orders for each patient about positioning and moving. If it's for icp monitoring and closed to drain I don't see why they can't move as long as it's at the correct level and zeroed. I mean we let people with evd icp monitoring move.