LUMBAR DRAINS FOR VASCULAR PROCEDURES: AN INSTITUTIONAL PROTOCOL REVIEW AND GUIDELINES.

Abstract

BACKGROUND\nAortic disease requiring open or endovascular repair may result in spinal cord injury in approximately 2-10% of patients. Cerebrospinal fluid (CSF) diversion using lumbar drains (LD) has been validated as a protective measure to mitigate this complication.\n\n\nMETHODS\nThis single-institution retrospective study analyzes the implementation of a standardized protocol and subsequent educational intervention for LD for aortic vascular procedures over a four-year period.\n\n\nRESULTS\nFrom 2016-2019, 45 patients had LD placed for open or endovascular procedures; Group 1 included 19 patients who had the LD placed prior to protocol implementation, and Group 2 included 26 patients with LD placed as per the institutional protocol. Demographics and procedural details between both groups were similar. However, there was a significant difference in the number of patients who had emergent versus planned placement of the LD (Group 1 89.5%; Group 2 50%, p<0.01), volume of CSF drained (Group 1 453 cc; Group 2 197cc, p<0.01), and compliance with a 10cc/hour drainage recommendation (Group 1 68.4%; Group 2 100%). Five (31.6%) patients in Group 1 had neurological complications compared to only one (3.8%) in Group 2; three patients (15.8%) in Group 1 experienced LD related complications compared to none in Group 2. Survey results suggested increased healthcare worker protocol familiarity with educational interventions.\n\n\nCONCLUSION\nImplementation of an institutional protocol for LD for open or endovascular procedures is feasible and beneficial. Educational modules improve familiarity among all healthcare providers, which can improve patient care and complication avoidance.