lumbar drain difficulties

[dannyboy]

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hey guys,

my current group uses these Medtronic lumbar drainage catheter systems for our lumbar drains. We put them in for our TEVAR patients.

These Medtronic kits we use have a very flimsy 80cm catheter that also includes a guidewire-like contraption. Most of my partners do not use the rigid guidewire because of fear of threading the catheter into nerve roots, etc.

Lately, I've been finding that even after inserting the spinal needle and getting a waterfall of clear CSF spilling onto the bed and being able to aspirate CSF freely, I have trouble inserting the catheter. It seems to get hung up at about 10cm, which is probably where it is exiting the needle. I've had to resort to using a regular Arrow 19g spring-loaded epidural catheter on a number of occasions.

Have you guys difficulties with threading the catheter into the intrathecal space? If so, have you found that you've had to resort to using the guidewire?

And finally, what other lumbar drainage systems are you guys using that might be better than Medtronic?

Thanks so much for the input.

 

[92122]

I always use the wire without issue. Shouldn't be a problem.

 

[nimbus]

We use the same system. I use the guidewire every time and have had no difficulties. Preload guidewire into soft catheter>big tuohy into subarachnoid space>catheter into subarachnoid space>tuohy out>guidewire out>dressing

Catheter won't hang up if you use the wire.

 

[dannyboy]

Thanks for the input! That was very helpful.

 

[gasattack3]

Thanks for the input! That was very helpful.

you guys use fluoro for lumbar drain placement?

 

[92122]

I haven't used fluoro for verification of anything other than CSC placement.

 

[drccw]

Be very very careful with the wire.. it should go nice and easy.. if it doesn't, then done jiggle or push/pull it.. there have been a reasonable number of reports of the wire shearing....

drccw

 

[gtb]

When I cannot thread the catheter, my thinking is that I'm up against the back membrane, partially through the back membrane, or maybe I'm only partially through the front membrane. I do these three things in sequence, and it will usually thread.
1. Slightly change the angle of my tuohy and push on the catheter. If I'm up against the back wall changing the angle lets the catheter exit the needle without getting hung up on the back wall. Usually I push caudal on the wings so the tip moves slightly cephalad, but it depends on the entry angle and needle tip orientation.
2. Rotate the needle maybe 30 - 45 degrees and push on the catheter. If up against the back wall, or just partially through the front, this can reorient the orientation of the tuohy so the catheter can exit with less pressure.
3. Pull back the tuohy a little bit (on the order of 1 - 2 mm or so), check to see if you've got freely flowing CSF, and try to thread again. Works if you're up against the back wall, or maybe even partially through the back wall. If you don't get freely flowing CSF when you back out then you know you were only partially through the front membrane, and push forward until you get CSF and effectively start over.

 

[DrN2O]

These Medtronic kits we use have a very flimsy 80cm catheter that also includes a guidewire-like contraption. Most of my partners do not use the rigid guidewire because of fear of threading the catheter into nerve roots, etc

I've had to resort to using a regular Arrow 19g spring-loaded epidural catheter on a number of occasions.

Are they the same people that think the glidescope stylet is evil? I'm not sure why some anesthesiologists feel they know better than the manufacturers about the specialized equipments they make. If the 80cm catheter comes with the guide wire, it does so for a reason-use it. You don't see the surgeons ignoring the reps about their equipment. Have you tried to thread the limpy catheter through the tuohey? I would be more afraid of shearing the catheter on the tuohey if I had trouble advancing and had to pull it back through the needle.

 

[fakin' the funk]

my current group uses these Medtronic lumbar drainage catheter systems for our lumbar drains. We put them in for our TEVAR patients.

Hm. Isn't the data on CSF drains in open repairs pretty equivocal, let alone endovascular repairs?

 

[B-Bone]

Hm. Isn't the data on CSF drains in open repairs pretty equivocal, let alone endovascular repairs?

this. there was a great pro/con debate on this at last year's SCA CPB conference. Even the pro guy was not super enthusiastic. They mostly agreed that if you had someone available inhouse to place one in the event of neurologic symptoms, that would probably be best (as opposed to placing them prophylactically and incurring risk of hematoma/trauma/etc in patients without symptoms). I don't place them prophylactially unless the surgeon documents that he requires it for open TAAA, and never for endovascular procedures.