Spinal Cord Injury

FACTS

 

HPI

 

PHYSICAL EXAM

IMAGING

 
A/P
Acute management
  • place foley
  • place A-line
  • place lumbar drain

    Chronic management
  • Clean intermittent catheterization
 

Spinal Cord Perfusion Protocol

Flowchart

notion image

The orders (attached)

Required monitoring:
  • Invasive blood pressure (MAP) until SCPP treatment is discontinued.
  • Intrathecal pressure (ITP) via lumbar drain.
  • Urine Output: via Foley catheter minimum 48 hours
Physiological Goal: Establish and maintain SCPP > 65 mmHg.
  • SCPP = (MAP- ITP)
Methods to achieve goal: Volume expansion, vasopressor support, lumbar CSF drainage.
Nursing Staff:
  • Lumbar Drain to be leveled at right atrium, zero transducer every shift.
  • Keep lumbar drain closed all times except for CSF drainage.
  • Label ITP as ICP on bedside monitor.
  • Document MAP, ITP and SCPP hourly, before and after CSF drainage and changes in vasopressor doses
  • Drain CSF only when SCPP < 65 mmHg and ITP is > 15 mmHg.
  • Maximum hourly drainage = 15 ml
MD/APP Orders: (Cerner CPOE Orders Bold/Italicized)
  1. Vital signs: Q 1 hour X 72 hours, then q 2
  1. Intake and Output: Q 2hours until Foley removed.
  1. Neurological checks: q 2 hours X 72 hours
  1. Foley catheter
  1. Norepinephrine drip (16 mg/250): Start at 0.1 mics/kg/min, titration goal: SCPP > 65 mmHg.
  1. Lumbar Drain
    1. Drain Status: closed.
    2. Drainage amount: up to 15 cc
    3. Frequency: q 1 hour
    4. Keep ITP < 15 mmHg.
    5. Special Instructions: only if SCPP < 65 mmHg.
  1. Notify, other
    1. Neurosurgery for: Damped lumbar drain waveform, Lumbar drain not draining or tidaling, change in neurological status or severe headache
  1. Communication to NursingContinuous:
    1. Document MAP, ITP and SCPP hourly