Lumbar Drain

What is a lumbar drain?

A lumbar drain is a small, flexible tube that removes cerebrospinal fluid from the spinal column in your lower back.

Your brain and spinal cord (the bundle of nerves that runs up and down the vertebrae) are surrounded by a fluid made up of water with some salt and important proteins. This fluid is called cerebrospinal fluid (CSF).

In some cases, healthcare providers learn about certain diseases by studying this fluid, much like they can learn about certain other diseases by taking a sample of blood. In the case of CSF, not only can there be abnormal things in the fluid, but sometimes, the pressure can also be abnormally high or low.

A healthcare provider will place a lumbar drain in your lumbar spine. This is in your lower back, usually about two to three inches above your butt. As the fluid circulates around your brain and spine, taking it out from your lower back will provide the same information as taking it from your neck or head, and it’s safer.

While the tube is in, your provider will use a lumbar drain to:

• Externally remove excess CSF.
• Measure the amount of CSF in your body.
• Look for abnormal cells or proteins in the CSF or other signs of things not working right.
• Monitor intracranial pressure (pressure inside of your skull).

A lumbar drain is usually only temporary. It’ll stay in your body for a few days before removal.

What does a lumbar drain manage?

Your healthcare provider may recommend a lumbar drain if you:

• Have a cerebrospinal fluid leak: The fluid surrounding your brain and spinal cord might be leaking out into your body. This can occur after an accident or trauma, but it sometimes happens on its own, out of the space where it’s supposed to stay.
• Have normal pressure hydrocephalus: CSF builds up inside of your skull and puts pressure against your brain.
• Had surgery. Sometimes, a surgeon will recommend a lumbar drain after brain or spine surgery to lower the pressure around your brain or nerves so your body can heal. You might need one right after surgery or sometimes, weeks or months later.

How should I prepare for a lumbar drain?

Your provider will evaluate whether a lumbar drain will be an effective form of treatment after performing a physical exam, neurological exam and ordering tests. They’ll review your medical history and may recommend an MRI or a CT scan. These tests help your provider to see what is going on inside your body. It also helps them determine the best location to put the drain.

If necessary, your provider may offer additional instructions like taking antibiotics to reduce your risk of infection. Your provider may recommend a medication to lessen your body’s production of CSF to reduce the pressure inside your brain and spine before the procedure.

You’ll also learn about the risks and benefits of the procedure before signing an informed consent document. If you have any questions about your care, let your provider know.

What happens during a lumbar drain?

To complete a lumbar drain, your provider will:

1. Position your body, with you lying on your side.
2. Clean the skin on your lower back.
3. Mark your skin where they’ll put the drain.
4. Give you a local anesthetic injection to prevent pain.
5. Insert a needle to reach the space where the lumbar drain catheter will sit. In some cases, your provider will use an X-ray machine to guide the needle into the correct spot.
6. Push the small, thin tube through the needle.
7. Remove the needle but leave the tube in your body.
8. Attach the catheter to a CSF collection system (a collection bag or reservoir).
9. Secure the catheter to your skin with sutures (stitches) or sticky dressings and place a bandage over the drainage site to keep everything clean.

Lumbar drain placement

Your healthcare provider will insert a lumbar drain into your lower back, in between two of the vertebrae (usually between the L4 and L5, the lower vertebrae, but sometimes a little higher). The drain will reach inside from the skin, through the muscle, past the bone and inside the fluid. This is the subarachnoid space (intrathecal space). This is the area in your spinal canal between your spinal cord and the membrane that surrounds it. It’s where your spine holds cerebrospinal fluid.

Do you have to lay flat with a lumbar drain?

When getting the lumbar drain, you may need to lie on your side while your provider inserts the lumbar drain. After the drain is in, you can rest by lying flat on your belly or on your side. Your provider will give you instructions specific to your situation and comfort level. Many times, you’ll be allowed to spend some time on your back afterward.

How long does it take to put in a lumbar drain?

It usually takes around 30 minutes to insert a lumbar drain into your body.

What happens after a lumbar drain is inserted?

You’ll stay in a hospital while the lumbar drain is in your body. This is usually a few days. Your care team will regularly check on how you’re doing and monitor any symptoms you experience. They’ll also check the CSF pressure within your body and change the drainage collection bag when it fills up.

You’ll need to rest while the lumbar drain is in place to prevent it from dislocating (moving position). This can be difficult to do if you’re an active person, but your care team will offer solutions to help you stay as comfortable as possible.

It’s best, while you have the lumbar drain in, to contact a caregiver before sitting up or getting out of bed unless you have been specifically told otherwise. A caregiver can turn the drain on and off to control the amount of fluid that comes out. For example, if the drain is open and you stand up, it can cause too much fluid to come out.

When your CSF levels are stable, your provider will remove the lumbar drain catheter completely from your body. Your provider will give you instructions to care for yourself after catheter removal. This could include lying flat for a set amount of time to prevent complications like a headache.

What are the benefits of a lumbar drain?

The benefits of a lumbar drain include:

• It helps stop CSF leaks.
• It regulates CSF levels.
• It’s a diagnostic tool for a provider to test your CSF.
• It provides access to your spinal canal (for medication delivery or surgical access).

A lumbar drain can prevent damage, and in some cases, be a life-saving procedure if excess CSF puts too much pressure on your brain.

How successful is a lumbar drain?

Two studies reported similar findings that 98% of lumbar drains were successful at stopping CSF leaks. While the procedure itself has good results, complications can be frequent.

What are the complications of a lumbar drain?

Complications are possible and include:

• Bacterial infection.
• Headache.
• Nausea and vomiting.
• Bleeding.
• Over-drainage of CSF.
• Air in the subarachnoid space (pneumocephalus).
• Intracranial hemorrhage (bleeding inside or around your brain).
• Movement or pullout of the catheter (may require replacement).

Your care team will take extra precautions to reduce your risk of lumbar drain complications. This is another reason it’s important to follow instructions from your healthcare team, especially when it comes to moving around and getting up.

How long can a lumbar drain stay in?

A healthcare provider may leave the lumbar drain in your body for a few days but usually no more than five days. After five days, your risk of complications, like infection, increases. Your provider will remove the drain when your CSF levels are stable.

After drain removal, you’ll need to rest and take it easy. Your provider will let you know what activities are safe to do until your body fully heals. Avoid any strenuous activity or heavy lifting until your provider gives you the “all clear.”

When should I call my healthcare provider?

You’ll be in a setting with constant care available to you while the lumbar drain is in. If you feel any new symptoms like pain, a severe headache or nausea, let a provider know right away. This is true after you go home as well.