lateral spinals

[cleansocks]

Anyone ever have trouble getting CSF back in laterally positioned spinals? During a couple this week I felt what I am accustomed to feeling when I get in the right spot, midline and paramedian, the patients were relatively thin, but got nothing back. I managed to succeed in placing a lateral one today but the CSF came back REALLY slowly. Is CSF pressure much lower in lateral position?

Or is it just poor aim?

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[Noyac]

It should not flow more slowly.

 

[Brookstacular]

Depends on needle size, age, location, and aim. I do 90% of my spinals lateral and CSF flow isn't like a geyser but definitely not slow. Maybe 1 drop per second. Use a 22G Gertie-Marx next time and see how slow it comes back. Really though, if it flows slowly and aspirates, who cares? That's probably better for risk of PDPH.

 

[Wiscoblue]

I can't say that I have noticed a difference between sitting and lateral. Maybe because my syringe of injectate is connected to the spinal needle before a single drop hits the sheets.

 

[cleansocks]

anyone put a roll or pillow under their flank to straighten out the spine?

 

[pgg]

A few weeks ago I watched in silent agony as a neurosurgery resident tried to place a lumbar drain in an asleep lateral patient. Had to have made at least 30 passes over what seemed like forever.

He began to theorize aloud that maybe the reason he wasn't getting CSF back was because the patient was lateral, no CSF column like in a sitting patient, hence lower pressure. I waited for his staff to say "don't be ridiculous, that's a 17g needle, when you strike oil you'll know it" ... only to hear him agree that flow would be greatly reduced. I did not get involved in either the conversation or the procedure.


I can't say I've ever noticed a big difference sitting vs lateral. I believe there's probably some difference but I doubt its clinical significance. The only things that seem to slow down CSF flow IME is a thinner needle (27g vs 25g) and or long needles for the ultra-BMI-challenged.

 

[Wiscoblue]

It is true that csf is harder to hit with that huge spinal drain needle than it is with a 24 sprotte don't ask me why. I struggle with spinal drains.