This document provides guidelines for managing spinal drains post-operatively. It states that the drain should be set up so that the drainage chamber is 13.5cm above the spinal cord to allow drainage of CSF if pressure rises above normal. It emphasizes that the drain and patient must not be moved without clamping the drain to avoid complications. It outlines important monitoring parameters, signs that indicate issues like increased CSF drainage, and procedures for drain removal and resuming anticoagulation.

1. SPINAL DRAINS
POST-OPERATIVE MANAGEMENT
IN RECOVERY/ITU/HDU
Rachael Lear
Advanced Vascular Nurse Practitioner

2. CLAMP DRAIN
FOR PATIENT TRANSFER

3. 13.5cm
Zero level
SET-UP
Patient horizontal or 30 degrees head up position
Zero mark on measuring tape (attached to drip stand) is level with external meatus (mid
ear).
Position drain so that the pressure level is level with the 13.5cm mark on the measuring
tape

4. 13.5cm
Zero level
Why is the set up important?
Normal CSF pressure is 10mmHg
13.5 cmH20 = 10mmHg
If the drain is kept at 13.5cm above the spinal cord, CSF will drain into the
chamber if the pressure rises above normal.

5. The Golden Rule
DO NOT MOVE THE PATIENT OR THE
CHAMBER WITHOUT CLAMPING THE DRAIN
Chamber too
high
Reduced CSF
drainage
Increased
CSF pressure
Paraplegia

6. The Golden Rule
DO NOT MOVE THE PATIENT OR THE
CHAMBER WITHOUT CLAMPING THE DRAIN
Chamber too low
Excess of CSF drainage
Reduced intracranial
pressure
‘Coning’ of
brain/intracranial bleeding
Subdural
haematoma
caused by tearing
of the dural
bridging vein
attributed to
excessive CSF
drainage
Murakami et al. 2004

8. • Are all the 3-way taps covered with a bung?
• Is the drain labeled? “Spinal drain: NOT for
injection”
• Is the bed locked to prevent it from being moved
up/down?
• Do all the staff know that your patient has a
spinal drain? (including the domestics!)
• Does your patient know that they have a spinal
drain and the implications for their position in
bed/mobility?
• No warfarin/clopidogrel
• Do you know who to call if the patient develops
neurological deficit?

9. MONITORING: PATIENT PARAMETERS
MAP >85-90 mmHg (inotropes)
Haemoglobin >10 g/dl
PO2 7.3 – 10.6 kPa
O2 saturation >95%
Spinal cord
perfusion
pressure
=
MAP - CSFP

10. MONITORING: HOURLY NEURO OBS

11. MONITORING: VOLUME & COLOUR OF CSF
• Measure & record the volume & colour CSF drained hourly.
• If >10mls/hour or 5-10mls for 2 consecutive hours, inform the
vascular registrar immediately.
• If CSF has not drained for a period of two consecutive
hours, nursing staff should check patency of spinal catheter.

12. TO CHECK CATHETER PATENCY
STRICT ASEPTIC TECHNIQUE

13. TO CHECK CATHETER PATENCY
Aspirate
0.5mls max
Clamp
closed to
chamber
Three-way
tap open to
the patient

14. Colour/clarity of CSF
Bloody CSF can indicate spinal haematoma/ intracranial haemorrhage
5% (24/486) patients with spinal drain  bloody CSF
17/24 patients: CT demonstrated intracranial haemorrhage

15. • ITU: sedation hold every morning to check neuro status & motor
function
• Insertion site check every 12 hours for evidence of infection/CSF
leak
• Drain may be clamped briefly (<5 minutes) for care activities
• Prophylactic LMWH can be given daily
• NO INTRATHECAL INJECTIONS via spinal drain
• CPAP increases CSF pressure & may lead to paraplegia:
commencing CPAP is a consultant decision
MANAGEMENT: other important points

16. REMOVAL: ANTICOAGULATION
• 12 hrs after last dose of SC
clexane (up to 40mg)
Restart 4 hrs after removal.
• IV heparin infusion:
stop infusion, wait until APTR
normal, remove drain.
Restart infusion 4 hrs after
removal.
• Other: seek advice from
haematology

17. REMOVAL: PROCEDURE
• Check clotting/platelets/timing of last
heparin dose
• Aseptic technique
• Check complete removal by
looking for blue tip
• Apply a transparent occlusive dressing once the catheter is
removed and Inspect the insertion site every 2 hours for 24
hours, looking for CSF leak
• Neuro obs for 24hrs
• Handover timing for safe administration of anti-coagulation