title: The safe use of spinal drains in thoracic aortic surgery.
abstract: Paraplegia is a devastating complication which may occur following surgery on the thoracic aorta. The use of a cerebrospinal fluid drain (CSFD) has helped reduce the incidence of neurological deficit; however, the management of patients with a CSFD postsurgery requires nurses and doctors to have expertise and awareness of the associated complications. The National Patient Safety Agency (UK) has highlighted a number of cases involving inadvertent spinal injections throughout the UK National Health Service (NHS). To this end we have introduced a protocol or 'care bundle' for safe CSFD care as well as drain management. The protocol was developed by medical and nursing staff at our institution based on clinical experience and literature reviews over a two-year period (2008-2010). Interventions undertaken during the development of the protocol included discussion with the UK National Patient Safety Agency (NPSA). Content of the protocol was reviewed by internal regulatory bodies within the hospital prior to ratification and general dissemination. Clear guidance is given within the policy on the standards expected when caring for the line and managing drainage according to agreed parameters of spinal cord perfusion pressure. The protocol constitutes five documents which guide staff in the care of CSFD, its routine management, documentation and interventions necessary once neurological deficit is detected. Document 1 which is a checklist, communication tool and aide-memoire was developed to ensure effective management, when the patient arrives in intensive care unit (ICU) from theatre. Document 2 ensures that early detection of a neurological deficit is noted and with Document 3 is acted upon immediately to reverse the injury. Document 4 provides information on the safe administration of analgesia via the spinal drain and has reference to the Glasgow Coma Scale. Document 5 is a bespoke observation chart for documenting CSFD pressure and cerebrospinal fluid drainage. In conclusion, the protocol acts as a guide for safe management of the CSFD and directs staff in reacting to detection of neurological deficit.
authors.affiliation: Institute of Cardiovascular Medicine and Science, Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L1 43PE, UK. mark.field@lhch.nhs.uk
authors.forename: Mark
authors.initials: M
authors.lastname: Field
authors.forename: Jim
authors.initials: J
authors.lastname: Doolan
authors.forename: Maria
authors.initials: M
authors.lastname: Safar
authors.forename: Manoj
authors.initials: M
authors.lastname: Kuduvalli
authors.forename: Aung
authors.initials: A
authors.lastname: Oo
authors.forename: Keith
authors.initials: K
authors.lastname: Mills
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kendall
authors.forename: Michael
authors.initials: M
authors.lastname: Desmond
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery*; D015170:Cerebrospinal Fluid Pressure; D057189:Checklist / Q000592:standards; D002985:Clinical Protocols / Q000592:standards*; D004322:Drainage / Q000009:adverse effects / Q000592:standards*; D004739:England; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D059032:Learning Curve; D010264:Paraplegia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D019990:Perioperative Care / Q000592:standards; D016730:Program Development; D013129:Spinal Puncture / Q000009:adverse effects / Q000592:standards*; D013222:State Medicine / Q000592:standards; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects