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Cqi lumbar drain- 1-17-2012
1. “The patient came for surgery, not
your lumbar drain placement...”
Michael Shelton, MD
Jim Sp rrow, MD
1/17/2012
2. Patient History
68 yo WM with TAAA, presumably mycotic
PMH
ESRD
CAD s/p NSTEMI
PUD
OSA
PSH
kidney transplant 2008
CABG x5
B TKA 2001
T&A
cholecystectomy
AVF
3. Patient History
Medications
Omeprazole
ASA
prednisone
bactrim
tamulosin
citalopram
lisinopril
Allergies
butorphanol
Social Hx
retired, denies EtOH/drugs/tob
Family Hx
noncontributory
4. Patient History
PE
WNL
Imaging
5.5 cm TAAA, 8.6 cm segment
Laboratory
BUN 20, Cr 2
PT 14.5/INR 1.16
PTT 22
Plt 155
5. Admission #1
10/9- admitted to UAB for open TAAA repair
10/10- lumbar drain placement
#1-> clear CSF, unable to advance catheter
without/with guidewire
#2...∞-> serosanguinous to bloody fluid
Procedure aborted- pt to CICU for q2h
neuro checks
10/11- pt discharged without sequelae
6. Admission #2
“readmission to CICU in 12/07/2011”
“underwent attempted lumbar drain
placement with the anesthesia attending
where multiple attempts were made at
placing the drain. All attempts however,
were again unsuccessful and so drain
placement was aborted.”
“agreed risk of surgery without lumbar drain
placement likely outweighed benefits and
therefore the scheduled procedure of TAA
repair was again canceled.”
10. Cheung et al.- U
Penn-2003
“silicon elastomer catheters stretch under
tension during removal, which make it
difficult to judge the tensile strength of the
catheter and also difficult to detect if a
buried portion of the catheter has become
trapped under the skin.”
“should be performed only by physicians who
are familiar with the catheter insertion and
the tensile strength and material
characteristics of the catheter.”
14. Wynn et al.- U
Wisconsin- 2009
“because of an unacceptable number of drain
failures and difficult drain insertions,
a...larger drain (Medtronic EMD) was placed
under fluoroscopy...”
15. References
Cheung AT, Pochettino A, Guvakov DV, et al. Safety of lumbar
drains in thoracic aortic operations performed with
extracorporeal circulation. Ann Thorac Surg 2003;76:1190-1197.
Rughani AI, Nader R. Lumbar external drainage system.
Medscape Reference 2011. http://emedicine.medscape.com/
article/1983401-overview. Accessed 1/14/2011.
Gold MM, Miller TS, Farinhas JM, et al. Computed tomography-
guided lumbar drain placement. J Neurosurg Spine
2008;9:372-373.
Wynn MM, Mell MW, Tefera G, et al. Complications of spinal
fluid drainage in thoracoabdominal aortic aneurysm repair: A
report of 486 patients treated from 1987 to 2008. J Vasc
Surg 2009;49:29-35.
16. References
Federow CA, Moon MC, Mutch WA, et al. Lumbar cerebrospinal
fluid drainage for thoracoabdominal aortic surgery: rationale
and practical considerations for management. Anesth Analg
2010;111:46-58.
Subarachnoid lumbar drains: a case series of fractured
catheters and a near miss. Can J Anesth 2007;54(10):829-834.
Wong DR, Parenti JL, Green SY. Open repair of
thoracoabdominal aortic aneurysm in the modern surgical era:
contemporary outcomes in 509 patients. J Am Coll Surg
2011;212:569-581.
Ackerman LL, Traynelis VC. Treatment of delayed-onset
neurological deficit after aortic surgery with lumbar
cerebrospinal fluid drainage. Neurosurgery 2002;51:1414-1422.
