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Extended CSF drainage trial via lumbar drain

What is a lumbar drain?

A lumbar drain is a small flexible tube that is placed in the lumbar spine. The tube drains some of the cerebrospinal fluid that fills the ventricles of the brain and surrounds the brain and spinal cord. In assessing normal pressure hydrocephalus, draining cerebrospinal fluid for a few days is helpful in determining if the patient will benefit from a shunt.

Learn more: Read our Spinal Fluid Drainage from a Lumbar Catheter patient information handout.

The Lumbar Drain Procedure

  • An antibiotic will be given to reduce the risk of infection.
  • You will be asked to sit in a special chair or lie down on one side of the bed.
  • The area where the spinal needle is inserted will be marked with a marking pen.
  • The lower back will be cleaned thoroughly with an antiseptic solution and allowed to dry.
  • The back will be covered by a sterile drape.
  • A local anesthetic will be injected in the skin, which may cause burning for a few minutes.
  • The spinal needle will then be inserted in the area marked and directed towards the spinal canal. If there is arthritis of the spine, the needle may have to be re- directed until the right space is reached.
  • You will feel dull pressure as the needle is advanced. If you feel a sharp pain, you should let the doctor know so that more local anesthetic can be given.
  • Once the needle is in the right space, a flexible catheter is inserted through the needle.
  • The needle is then withdrawn and the catheter is held to the lower back with a sterile bandage and connected to a pressure transducer.

The drain remains in place for 2 to 3 days. Even if you did not respond to a single large volume tap, this extended drainage may indicate that you could respond to a shunt.

Preparing for the Procedure

You will be scheduled 3 to 7 days before your drain to run a few tests. You will have appointments with a physical therapist and an occupational therapist to test your balance and your ability to perform daily tasks. A doctor will assess memory and other brain functions, and a nurse will test your ability to walk. Lab tests, including blood and urine tests, will help to ensure you have no bleeding tendency or infection. If these tests are abnormal, your procedure may be rescheduled.

After the Procedure

Sometimes, after the lumbar drain is pulled out, fluid continues to leak from the small hole left by the tube. A simple stitch is placed in the skin to close the wound, and this can be removed in a week.

Any improvement in symptoms that you may experience in the hospital will only last for a few days. You should expect your symptoms to return to their usual state after you leave the hospital.

Possible CSF Drainage Trial Side Effects

Infection: There is a 3% to 4% risk of infection with this procedure, despite all safety measures. The infection, meningitis, is serious, but treatable with a 14-day course of intravenous antibiotics.

Leg or back pain: Occasionally, the spinal needle or catheter can touch a nerve root in the lumbar space, causing a brief pain shooting down the back or leg. Moving the body to a different position usually alleviates the pain. There is rarely any lasting injury to the nerve root.

Headache: If too much fluid is removed, you may develop a headache, which will get worse when sitting or standing. Stopping the fluid drain for a few minutes will usually alleviate the headache. If you develop a similar headache after the tube is removed, drinking plenty of caffeine-containing fluids and taking ibuprofen or acetaminophen can bring relief. If this kind of headache persists, you can receive a blood patch to seal the fluid leak.

Bleeding: Bleeding is minimal during the procedure. There is a potential for bleeding around the brain if excess fluid is drained. This procedure has been performed over 1,000 times and only one patient experienced blood inside the skull. This patient had to have surgery to remove the blood. To decrease the chance of this complication, please notify the nurse when you change positions or have to use the bathroom.

Dizziness or light-headedness: Sometimes you may feel light-headed or dizzy when you stand up. This may be a sign of excess fluid drainage and stopping the fluid drain for a few minutes could make the dizziness stop.

Spinal fluid leak: Rarely, spinal fluid may leak around the catheter and its dressing. If it leaks onto a non-sterile area, the physician may decide to remove the catheter. Depending on how much you have drained, a new one may be put in or multiple spinal taps may be done to drain more spinal fluid.

When to Alert the Nurse or Doctor

Let your practitioner know immediately if you:

  • Develop a fever, severe headache, nausea or vomiting
  • Feel dizzy or light-headed when you sit or stand
  • Notice the lumbar drain tube or system gets disconnected or the presence of  fluid in the bed or a leak from your lower back

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Maryland Patients

Thank you for your interest in the Cerebral Fluid Center at Johns Hopkins. Learn how to refer a patient.

Adult Neurology: 410-955-9441
Pediatric Neurology: 410-955-4259
Adult Neurosurgery: 410-955-6406
Pediatric Neurosurgery: 410-955-7337

 

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