Document control in on-line version only
University of Alberta Hospital
Mazankowski Alberta Heart Institute
Kaye Edmonton Clinic
Patient Care Procedure
Name: Nursing Management of External
Lumbar Drainage Systems
Date Effective: February 6, 2013 Supersedes: same procedure approved
Updated: March 24, 2014 January 27, 2005
Providers: Health Care Professional with Approved By: (original signed by site Vice
Specialized Clinical Competency President)
Table of Contents:
Purpose
Physician/Nurse Practitioner’s Required Orders
Assessment
Safety Precautions
Patient/Family Education
Potential Complications
Insertion of Lumbar Catheter
Removal of Lumbar Catheter
Appendices:
1. Priming of the Medtronic Duet™ External Drainage and Monitoring System
2. Leveling the External Drainage Monitoring System
3. Flushing the External Drainage Monitoring System
4. Changing the Drainage Bag of the External Drainage Monitoring System
5. Obtaining CSF Specimen from the External Drainage Monitoring System
6. Changing the Lumber Dressing
7. Zeroing the External Drainage Monitoring System
8. CSF Drainage and Lumbar Subarachnoid Pressure Monitoring
9. Lumbar Drain Transport Guidelines
References
Page 1 of 23
Purpose
To promote dural healing by re-directing cerebral spinal fluid (CSF) away from a wound or
incision.
To protect the spinal cord from peri-operative ischemia which may occur with surgical cross-
clamping of the thoracic abdominal aorta. Drainage of CSF may reduce the incidence of
paraplegia associated with surgical repair of the descending thoracolumbar aortic aneurysm by
enhancing perfusion to the spinal cord.
A lumbar catheter with attached drainage system may be used to drain CSF and/or measure
lumbar CSF pressure.
The following conditions may require the use of a lumbar drain:
• Post-operative acoustic & pituitary tumors
• Cerebral spinal fluid leaks
• Hydrocephalus
• Post-operative thoracoabdominal aortic aneurysm repair (TAAA)
Physician/Nurse Practitioner’s Required Orders
• Height of drip chamber
• Level of zero reference point
• Level of head of bed (HOB)
• Drainage orders: usually includes: system open continuously, open intermittently or
closed to drainage, maximum drainage per hour(maximum usually 20ml/hr)
• Patient activity (if up in chair: height of drip chamber, open or closed to drainage, level of
zero reference point)
Assessment and Documentation
1. Dressing condition every 4 hours. Change dressing only when compromised; if wet
consult physician/nurse practitioner to assess
2. Insertion site for signs of infection every 4 hours (if visible through dressing)
3. Drainage system double secured to IV pole (every shift and with any movement of the
patient or the system)
4. Ensure all connections are tight and patent in order to maintain a sterile closed system
(every shift)
5. Neuro vital signs (NVS), vital signs every 4 hours minimum (report to physician/nurse
practitioner any changes including change in GCS, increased temperature, new onset
numbness or weakness of lower limbs, photophobia, nuchal rigidity, headache, nausea,
vomiting
6. Spinal signs (as ordered)
7. Patient activity
8. Head of bed at ordered height
9. Drip chamber is at the height (cm H20) ordered
10. Zero reference point on the drainage system is at the ordered level
11. Drip chamber stopcock is open or closed to drainage as ordered
12. Ensure all stopcocks are in correct position
13. Ensure stopcock off to drip chamber for all patient/bed position changes
Page 2 of 23
14. Color, clarity and amount of CSF every hour or as ordered
15. If monitoring lumbar CSF pressure(normal pressure 0-15mmHg), zero transducer
• Every shift
• After flushing
• Waveform issues
• Lumbar CSF pressure irregularities
Safety Precautions
Ensure all interventions are completed using aseptic technique.
Ensure:
1. All staff are aware patient has lumbar drain (sign at head of bed)
2. A health care provider qualified to care for a patient with a lumbar drain
accompanies the patient on all transports
3. Drainage system is double secured to IV pole
4. Dressing and tubing secure to avoid inadvertent catheter dislodgement
Patient/Family Education
Explain and reinforce the need to:
• Maintain the position of head of bed. Lock bed controls if possible
• Seek nursing assistance prior to changing position or getting out of bed
• Report motor/sensory deficits in lower limbs, headache, photophobia, stiff neck, or pain
at insertion site
• Minimize sneezing, coughing, or straining
Potential Complications
1. Localized Infection
Signs & symptoms may include:
• Errythemia at insertion site
• Purulent drainage at insertion site
• Elevated temperature
• Pain at insertion site
Nursing Interventions:
• Inspect insertion site (if transparent dressing) every 4 hours
• Report any abnormal findings to physician/ nurse practitioner
2. CNS Infection
Signs & symptoms may include:
• Elevated temperature
• Headache
• Cloudy CSF
• Nuchal rigidity
• Confusion & restlessness
• Photophobia
• Nausea/vomiting
Nursing Interventions:
• Maintain a closed sterile system
• Use aseptic technique for all interventions with the system
• Assess patient frequently
• Report any abnormal findings to physician/nurse practitioner
Page 3 of 23
3. Air in Subarachnoid Space
May occur as a result of air leaking in to the subarachnoid space during insertion of the
lumbar catheter or surgery
Signs & symptoms may include:
• Headache
• Fever
• Nuchal rigidity
Nursing Interventions:
• Report any abnormal findings to physician/nurse practitioner
4. Nerve Root Injury
May occur as a result of the catheter being placed against the nerve root or nerve damage
during surgery or catheter insertion
Signs & symptoms may include:
• Radiating leg pain
• Motor and/or sensory deficit in lower limbs
Nursing Interventions:
• Report any abnormal findings to physician/nurse practitioner
5. Excessive Drainage
May occur as a result of inappropriate leveling of the drainage system or overproduction of
CSF. 20 ml per hour is usually the maximum acceptable output. Physician will often order a
target amount of CSF drainage; follow specific order
Nursing Interventions:
• Level drainage system as ordered
• Ensure drainage system is double secured to pole
• Ensure stopcock under drip chamber is closed to collection bag
• Turn stopcock off to the drip chamber whenever patient changes position/surfaces
• Report drainage > 20ml or specified amount to physician/nurse practitioner
6. Subdural Hematoma (SDH)
May result from over drainage or from CSF draining too rapidly
Signs and symptoms may include:
• Decrease in level of consciousness, irritability, confusion, weakness, paresis, pupil
dilation/decreased reactivity
Nursing Interventions:
• Turn stopcock off to patient or drip chamber
• Call physician/nurse practitioner STAT
• Ongoing neurological assessment
7. Pneumocephalus/Herniation
May occur if CSF drains too rapidly. This creates a siphon effect that causes air to enter the
ventricles of the brain, which can result in brain compression
Signs & symptoms may include:
• Rapid neurological deterioration (decreased level of consciousness, pupil
dilation/decreased reactivity, abnormal flexion/extension of limbs)
Nursing Interventions:
• Turn stopcock off to drip chamber
Page 4 of 23
• Ongoing neurological assessment
• Place head of bed flat
• Administer oxygen
• Call physician/nurse practitioner STAT
8. No drainage/Under drainage
May occur as a result of stopcocks in the incorrect position, leakage from insertion site or
connections, air/debris/clots in drainage tubing, or drainage system incorrectly leveled
Nursing Interventions:
• Monitor and report leakage at insertion site
• Ensure stopcocks in correct position
• Ensure tubing is clear and connections are secure
• Assess for CSF fluctuation in tubing between drip chamber and main system stopcock
• Ensure system is at ordered level (drip chamber and zero reference point)
• Flush system away from patient as necessary (see Appendix 3)
• Notify physician/nurse practitioner if unable to resolve the issue
9. Separation of catheter from drainage system
Nursing Interventions:
• Immediately clamp catheter with plastic Kelly clamp and cover ends in sterile
towel/gauze
• Assess neurological status of patient
• Call physician/nurse practitioner immediately
10. Drainage system falls to the floor
Nursing Interventions:
• Immediately turn stopcock off to the drip chamber
• Assess neurological status of patient and amount of CSF that drained
• Reattach drainage system to pole
• Call physician/nurse practitioner to report incident and amount of drainage
• Re-level drainage device and reestablish drainage as ordered
11. Intradural Hematoma (IDH)
May result as a complication at the insertion site of a lumbar drain, or following removal
Signs and symptoms may include:
• Progressive lower limb sensory or motor deficit, loss of reflexes, pain at insertion site
Nursing Interventions:
• Call physician STAT
• Perform ongoing neurological assessments
Page 5 of 23
Insertion of Lumbar Catheter
Equipment
0.5% chlorhexidine solution
3-0 Dermalon suture material
Dressing for post procedure
• Transparent dressing (e.g., Tegaderm®) for insertion site
• Adhesive non-occlusive dressing (e.g., Mepore®) to secure lumbar tubing
• Waterproof tape to reinforce the connection between the catheter and drainage system
External lumbar drainage kit which includes:
• Spinal needle
• Lumbar catheter
• External drainage monitoring system
Local anesthetic and necessary supplies as specified by physician
Lumbar puncture tray
Mask for all staff during procedure
Minor suture bundle
Sterile gloves
Sterile towel
Action
1. Ensure procedure is explained to patient/family member by physician/nurse
practitioner/RN
2. Ensure external drainage system is primed (See appendix 1)
3. Perform hand hygiene
4. Don mask
5. Perform hand hygiene
6. Don sterile gloves
7. Assist physician/nurse practitioner with insertion of lumbar catheter as directed
8. Once physician/nurse practitioner has lumbar catheter sutured in place, pinch catheter
with fingers to stop flow of CSF
9. Ensure main system stopcock closed to the patient
10. Remove the cap from end of primed drainage system and attach to the lumbar catheter -
using sterile technique. Tape connection with waterproof tape
11. Apply sterile transparent dressing (e.g. Tegaderm®) over insertion site
12. Secure the lumbar catheter up the length of the patient’s back with adhesive non-
occlusive dressing (e.g., Mepore®)
13. Remove sterile gloves and perform hand hygiene
14. Remove mask and perform hand hygiene
15. Document procedure
16. Review patient care orders to ensure they meet the requirements listed on page 2
Page 6 of 23
Removal of Lumbar Catheter
1. Removal of the catheter is to be done by physician/nurse practitioner only. Pressure
should be applied to the catheter site for 5 minutes post removal
2. Apply a sterile transparent dressing (e.g. Tegaderm®) to the site after the device is
removed
3. Maintain bed rest, HOB ≤15 degrees X 4 hour if possible post removal, to minimize
headache. Monitor the dressing and site every 4 hours x 24 hours and document any
drainage. Monitor and document neurovital signs every 4 hours X 24 hours, or as
ordered
4. Instruct patient/family of the reason for position and to report any headache, pain or
wetness at insertion site, or lower limb weakness/numbness. Inform the physician/nurse
practitioner of:
• Swelling or drainage from the site
• Signs/symptoms of local or systemic infection
• Lower limb weakness/numbness
• Neurological changes in the patient
• Headache
Page 7 of 23
Appendix 1
Priming of the Medtronic Duet™ External Drainage and Monitoring System
Equipment and Supplies
• Sterile Gloves
• Mask
• Sterile Drape
• Medtronic Duet™ External Drainage and Monitoring System
• 2 - 10 ml Preservative Free Sterile 0.9 % Saline Syringes
• External Pressure Transducer (i.e. PX 600) if pressure measurements are ordered
• Pole
Procedure
1. Perform hand hygiene
2. Don mask
3. Open outer package of Duet™ EDMS
4. Prepare sterile field
5. Add transducer to sterile field
6. Add 2-10 ml 0.9% preservative free saline syringes to sterile field
7. Perform hand hygiene
8. Don sterile gloves
9. Attach the Duet™ EDMS to an IV pole using BOTH the built in pole clamp and hanging the
integral cord from the pole as a safety tether
10. Attach the main system stopcock to the Lumbar location on the side of the back panel(zero
reference point) as shown below
Page 8 of 23
11. Attach transducer (only if monitoring)
a. Remove the red cap from the main system stopcock
b. Attach external pressure transducer
12. Tighten all connections
13. Attach a 0.9% preservative free saline syringe to the patient line stopcock injection site. Rotate
the stopcock off to the drainage system and prime the short section of the patient line as shown
below:
Page 9 of 23
14. Turn the patient line stopcock off to the patient (section just primed) and prime the drainage
tubing all the way to the drip chamber. Inspect the system for air and use second 0.9%
preservative free saline syringe to ensure line primed thoroughly with saline and no air bubbles
exist
15. If applicable: Prime the pressure transducer by turning the main system stopcock off to the
drip chamber and flushing to ensure transducer is primed thoroughly with saline and no air
bubbles exist
• Replace end cap of transducer with new sterile dead end cap
16. Turn the patient line stopcock off to the syringe and remove the syringe from the patient line
stopcock injection site
Page 10 of 23
17. Turn main system stopcock off to the patient:
18. Connect the patient’s Lumbar catheter to the drainage system maintaining sterile technique, then
secure connection with waterproof tape
a. Ensure main system stopcock remains off to patient until properly leveled and
drainage orders received
Page 11 of 23
Appendix 2
Leveling the Medtronic Duet™ External Drainage System to the patient and opening the
system to drainage
Equipment and Supplies
• Clear-Site™ Laser Level
Procedure
1. Attach the Clear-Site™ Laser Level to the bracket on the back of the main system stopcock
2. Turn the laser on by pressing and releasing the black power button (Green LED indicates that the
laser is turned on) Avoid eye contact with laser beam
3. Direct the laser towards the landmark ordered by the physician. When the laser is level, the
bubble should rest evenly between the two black lines on the level
Page 12 of 23
4. Ensure main system stopcock off to patient. Raise or lower the drainage system (using pole
clamp) so the “zero” position on the pressure scale (level of the laser) is level with the ordered
zero reference point. Example: foramen of Monro: figure 1. (using the anatomical reference point
of midpoint when an imaginary line drawn from the outer canthus of the eye to the tragus of the
ear), the phlebostatic axis: figure 2. (4th intercostal space mid-point anterior/posterior chest wall),
or insertion site
Figure 1. Figure 2.
5. Using the blue knob at the top of the pressure scale, rotate the pressure scale to Lumbar cmH20
(The blue background)
Page 13 of 23
6. Raise or lower the drip chamber to the desired pressure level (cm H20) ordered
Follow specific physician order for amount and frequency of drainage
7. To drain CSF:
Ensure patient line stopcock is open
Open main system stopcock to drainage
Note: If the drip chamber is ordered to be leveled at >4cm H20, rotate pressure scale to Ventricular cm
H20 setting (black background). Remember to move transducer to Ventricular slot
Page 14 of 23
Appendix 3
Flushing the External Drainage Monitoring System
Equipment and Supplies
• Mask
• Sterile gloves
• 10 ml Preservative Free Sterile 0.9 % Saline Syringe
• 2 x 2% Chlorhexidine Gluconate and 70% Isopropyl Alcohol swabstick
• Sterile towel
• Sterile 4x4 gauze
Procedure
1. Don mask
2. Perform hand hygiene
3. Set up sterile field
4. Cleanse patient line stopcock port with 2% Chlorhexidine Gluconate and 70% Isopropyl Alcohol
swabstick – allow to dry
5. Close patient line stopcock off to the patient
6. Empty drip chamber (enter CSF amount in output) and close main system stopcock off to
transducer
7. Attach preservative free saline syringe to patient line stopcock
8. Flush line towards the drip chamber
9. If necessary, flush transducer: Cleanse end cap with 2% Chlorhexidine Gluconate and 70%
Isopropyl Alcohol swabstick – allow to dry, close main system stopcock to the drip chamber, open
shut off valve in transducer (horizontal position), remove end cap of transducer. Use sterile 4x4
to catch drainage at the open end of transducer and flush. Replace with new sterile dead end
cap. Return shut off valve to vertical position. If transduced, re-zero lumbar drainage system (See
Appendix 7)
10. Empty drip chamber of flush solution
11. Turn patient line stopcock off to the syringe and remove syringe
12. Ensure drip chamber and zero reference point is at prescribed level
13. Reestablish drainage as ordered
14. Remove gloves, perform hand hygiene
15. Remove mask, perform hand hygiene
16. Document procedure
Page 15 of 23
Appendix 4
Changing Drainage bag of the External Drainage Monitoring System
When bag is ¾ full
Equipment and Supplies
• Dressing Tray
• New Sterile Collection Bag
• Mask
• Sterile gloves
• 2% Chlorhexidine Gluconate and 70% Isopropyl Alcohol swabsticks
Procedure
1. Don mask
2. Wash hands
3. Prepare sterile field
4. Sterile Collection Bag
5. Add 2% Chlorhexidine and 70% Isopropyl alcohol swabstick to sterile field
6. Ensure stopcock under drip chamber is closed to collection bag
7. Wash hands
8. Don sterile gloves
9. Cleanse the connection port under drip chamber using 2% Chlorhexidine and 70% Isopropyl
Alcohol swab stick - allow to dry
10. Disconnect collection bag
11. Connect new collection bag
12. Discard ¾ full collection bag in the yellow Biohazard bin on unit
13. Document procedure
Page 16 of 23
Appendix 5
Obtaining CSF Specimen from the External Drainage Monitoring System
IMPORTANT NOTE: The drip chamber must be emptied into the collection bag prior to sampling.
Allow 2-3ml to re-accumulate in the drip chamber
To ensure accurate results from CSF sampling the entire volume collected in the drip chamber
should be sent
If the lumbar drain has been ordered closed, open the drain to allow only 2 mls (or required
amount) of CSF to accumulate in the drip chamber. Once accumulated, close main system
stopcock to drip chamber
Equipment and Supplies
• Dressing Tray
• One 3ml or 10ml sterile luer lock syringe (depending on sample size required)
• 1 or 2 sterile CSF tubes (2 - if cell count and C&S ordered)
• Mask
• Sterile gloves
• 2% Chlorhexidine Gluconate and 70% Isopropyl Alcohol swabstick
Procedure
1. Don mask
2. Wash hands
3. Prepare sterile field
4. Add sterile luer lock syringe sterile field
5. Add 2% Chlorhexidine and 70% Isopropyl Alcohol swabstick to sterile field
6. Ensure stopcock under drip chamber is closed to collection bag
7. Wash hands
8. Don sterile gloves
9. Cleanse sample port under drip chamber using one 2% Chlorhexidine and 70% Isopropyl Alcohol
swab stick - allow to dry
10. Attach luer lock syringe to sampling port under drip chamber
11. Aspirate ALL accumulated CSF from drip chamber
12. Separate collected CSF into appropriate number of sterile CSF tubes as required for each test
13. Document procedure
Page 17 of 23
Appendix 6
Dressing Change
Important note: Ensure dressing is changed as per physician preference
Equipment and Supplies
• 2X2 gauze
• 2% Chlorhexidine and 70% Isopropyl Alcohol swabstick
• Dressing Tray
• Mask
• Non-occlusive dressing (ex. Mefix)
• Non-sterile gloves
• Sterile gloves
Procedure
1. Perform hand hygiene
2. Don Mask
3. Open dressing tray, establish sterile field, add 2% Chlorhexidine and 70% Isopropyl Alcohol
swabstick, and dressing
4. Apply non sterile gloves
5. Remove previous dressing and place in appropriate receptacle
6. Perform hand hygiene
7. Apply sterile gloves
8. Cleanse insertion site with 2% Chlorhexidine and 70% Isopropyl Alcohol swab stick-allow to
dry
9. Cover with a transparent dressing or ordered dressing
10. Remove gloves, perform hand hygiene
11. Remove mask, perform hand hygiene
12. Report any leakage from the site to physician/NP
13. Document procedure
Page 18 of 23
Appendix 7
Zeroing the External Drainage Monitoring System
Only if Transduced for Monitoring Lumbar CSF Pressure
IMPORTANT NOTE: Zeroing of the pressure transducer is a change in practice – follow the
procedure as outlined below
Equipment and Supplies
• Primed Medtronic Duet™ External Drainage and Monitoring System (EDMS) with pressure
transducer
• Monitor
• Monitor pressure cable
Procedure
1. Attach the transducer cable to the monitor cable
2. Label the pressure waveform ‘ICP’
3. Select the scale (i.e. optimum)
4. Set the high/low pressure alarm appropriate to the patient
5. Ensure the main system stopcock is turned “OFF” to the patient as seen below:
6. Lower the drip chamber until the pressure indicator window is centered over the “0” position on the
pressure scale
Page 19 of 23
NB: Ensure that the tubing between the main system stopcock and the drip chamber is fluid filled
If it is not fluid filled, the zero will be inaccurate
Procedure: (In the event that the above red highlighted area in the picture is not fluid filled)
1. Open main system stopcock to drainage and allow CSF to fill the line without actually draining. If
at this point CSF is still not filled to the drip chamber, slowly lower the drip chamber until CSF fills
the line
a. You MUST remain with your hand on the stopcock until this occurs in order to avoid over
drainage
2. Turn main system stopcock off to patient immediately
3. Lower the drip chamber to the “0” position
4. Press Zero on the bedside monitor. The transducer is now “zeroed” to atmospheric pressure
5. Once the pressure transducer has been “zeroed”, raise the drip chamber back to the ordered
setting and resume drainage orders
6. Document procedure
Page 20 of 23
Appendix 8
Lumbar Subarachnoid Pressure Monitoring
Only if Transduced for Monitoring Lumbar CSF Pressure
Equipment and Supplies
1. Q1H (or as ordered) turn the main system stopcock “OFF” to the drip chamber so that the
transducer is open to communicate with the patient only, as pictured below:
2. Wait for waveform to stabilize on the monitor and record measurement
3. Return stopcock to original position as ordered
4. Document procedure
Page 21 of 23
Appendix 9
Lumbar Drain Transport Guidelines
General
IMPORTANT NOTE:
• If there is a physician’s order for the patient’s Lumbar drain to be open at a certain level the
Lumbar drain must be leveled, and open at all times including during transport and diagnostic
procedure (except MRI – See MRI Transport Guideline below)
• If the Lumbar drain is ordered to be open, it is necessary to temporarily close the Lumbar drain
when transferring the patient from bed to procedure table for diagnostics or for position changes
• If monitoring pressure, continue to do so during transport to/from diagnostic area, and during a
diagnostic procedure
• Assessment of neurovital signs, including pupillary response, must be monitored as ordered
during transport and diagnostic procedures
• The health care professional responsible for the patient’s care must communicate information
regarding the lumbar drain to all staff involved in caring for the patient (including staff in a
diagnostic area)
Equipment and Supplies
• Flashlight
• Clear-Site™ Laser Level
• Portable Monitor
Procedure
1. Obtain flashlight, Clear-Site™ Laser level, portable monitor
2. Connect the patient to a portable cardiac monitor as per unit procedure
3. Document all assessments and interventions in the patient record
MRI Transport Guideline
IMPORTANT NOTE: Medtronic Duet™ External Drainage and Monitoring System is
MRI compatible. The Clear Site™ Laser Level is NOT MRI compatible
Equipment and Supplies
• Flashlight (Not MRI Compatible)
• Clear-Site™ Laser Level (Not MRI Compatible)
• Portable Monitor (Not MRI Compatible)
Page 22 of 23
Procedure
1. Drain the CSF present in the drip chamber into the collection bag, document in output
2. Turn the main system stopcock ‘off’ to drip chamber
3. NOTE: Remove Clear-Site™ Laser Level before entering MRI suite
4. Remove the Lumbar drain from the IV Pole and lay beside patient
5. Transfer the patient to the procedure table
6. Connect the patient to the MRI monitor
7. At conclusion of procedure and once outside the MRI suite reattach the drainage system to the
pole(double secure) and reattach Clear-Site™ Laser Level to the drainage system
8. Elevate HOB to required level
9. Re-level lumbar drain as ordered
10. Open lumbar drain if ordered
11. Document procedure
References
1. Alberta Health Services Patient Care Procedure: Lumbar Subarachnoid Catheter
(Lumbar Drain) Inserted for Drainage of Cerebral Spinal Fluid. December 2007.
2. American Association of Neuroscience Nurses: Care of the Patient with a Lumbar Drain.
First Edition 1998, Second Edition 2007.
3. Bloch, J., & Regli, L. (2003). Brain Stem and Cerebellar Dysfunction after Lumbar Spinal
Fluid Drainage: Case report. Journal of Neurology, Neurosurgery, and Psychiatry, 7,
992-994.
4. Calgary Health Region. Lumbar Subarachnoid Pressure Monitoring. 03/04
5. Clevenger, V. (1990). Nursing Management of Lumbar Drains. Journal of Neuroscience
Nursing, 22(4), 227-231.
6. Medtronic. Intracranial Pressure Monitoring A Handbook for the Nursing Professional.
Retrieved June 21 2011, Medtronic Website
7. Medtronic Duet External Drainage and Monitoring System Quick Reference Guide, 2012
8. Mitchell, P. (1994) External Ventricular Drainage and Pressure Monitoring Education
Package. University of Alberta Hospital Education Program.
9. Thompson, H.J. (2000). Managing Patients with Lumbar Drainage Devices. Critical Care
Nurse, 5, 59-68.
10. Vancouver Coastal Health: Care and Management of the External Ventricular
Drain(EVD) using the Medtronic Duet™ External Drainage and Monitoring System,
January 2012
11. Weaver, K. D., Wiseman, D. B., Farber, M., Ewend, M. G., Marston, W., & Keagy, B. A.
(2001). Complications of Lumbar Drainage after Toracoabdominal Aortic Aneurysm
Repair. Journal of Vascular Surgery, 4, 623-627.
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