Sunday afternoon. I thought I'd have a few minutes to chart, having just opened my patient's lumbar drain. It takes thirty minutes to drain ten cc's on her, to I figured I'd just hop down to the station, enter a few orders, and hang out for twenty minutes or so.
Then the call bell rang.
"I have the worst headache ever" said the voice on the other end. "Worst headache ever" is a klaxon to a neuro nurse; it usually means something like a hemorrhage or herniation. And it was my patient who was complaining.
So off I trotted to see what the problem was. I found her sitting up in bed, at about a forty-five degree angle, with her hands pressed to her forehead.
Her lumbar drain was still open.
Now, then. A lumbar drain is a small, flexible, hollow catheter connected to a measuring device and a collection bag. You'd get one if you had a cerebrospinal fluid leak from somewhere in the whole brain/spinal cord complex. Basically, the premise is this: if you have a leak up high, we take some of the fluid off down low, so as to reduce the overall fluid pressure and allow the leak to close up.
Unfortunately, gravity is not your friend with these devices. The patient with a lumbar drain must remain flat and quiet while the drain is open, lest too much CSF drain out and remove the cushion that your brain depends on to stay in place.
My patient had gotten out of bed, walked to the bathroom and peed, then come back and sat up in bed. In ten minutes she'd drained five times what she normally would drain in a half-hour.
It was the first time she'd forgotten about the drain being open and I can guarantee that it'll be the last.
So I closed the drain, flattened out her bed, upped her IV fluids, and handed her the soda on the table. "Drink this," I said, "the caffeine will help." As soon as I had shot her up with some morphine I called the resident to let her know what had happened.
An hour later, when the headache had subsided, the patient asked me why it had been so bad. What could I say?
"Your brain was trying to migrate down into your chest" was the only reasonable way of putting it.
Tuesday, August 23, 2005
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5 comments:
Holy crap!
I've never seen a lumbar drain. Sounds pretty cool (as long as the patient lays flat). ;)
There is a lesson in this which we can all learn from, and it is that generally speaking your vital organs are best off in their original locations and positions. Brain in head, heart/lungs in chest, etc.
Just moving them about even a wee little bit can screw you up enormously.
You would think they would've remembered about the drain being open as as soon as they sat up!
My God, that's scary. One of my profs had a spinal fluid leak. He knew it was leaking because he's a Phys prof and just had a test procedure done for suspected meningitis. Long story short: he was driving on the freeway trying to get to the hospital with his spinal fluid leaking and his head aching unbelievably.
I had a lumbar drain back in August of 2005. I had a bad motorcycle accident in July and after several weeks, spinal fluid continued to leak out of my ear due to two fractures in my right temporal lobe. It took a couple days for the nurses to figure out how many cc's and how often they could drain, and once they did, I was relatively ok. Until I got the nurse from hell! She opened the drain and left the room. She had me draining for over 30 minutes (when in my chart it was very clear that I was better off with having a drain every hour at no more than 19 cc's) She drained almost 40 cc's from me and I kept pressing the button to get the nurse to come back in. I was in such pain it was indescribable. It almost felt like my head was imploading. I was in ICU for two weeks, but after it was all done, it fixed the spinal fluid leaking from my ear and I've basically recovered. I lost hearing in my right ear, vision in my right eye and I can't smell anything anymore...but all things considered, since I wasn't wearing a helmet and I flipped my motorcycle...I'm very very lucky.
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