Net Drainage as a Novel Metric for Irrigating Drainage Systems in Chronic Subdural Hematoma Management: A Case Report

BACKGROUND AND IMPORTANCE Chronic subdural hematoma (cSDH) is a common neurosurgical pathology with a projected increase in prevalence as the elderly population grows. Traditional treatment for cSDH involves burr hole drainage or craniotomy with or without a subdural drain. This case describes a novel irrigation and drainage protocol using IRRAflow dual-lumen catheter system that utilizes early irrigation and measurement of the net fluid output to improve postoperative outcomes. CLINICAL PRESENTATION A 75-yr-old male presented to the emergency department with 2 wk of progressive dizziness, headache, confusion, and left-sided weakness over the past week. Computed tomography (CT) of the head showed 25-mm-thick, right-sided cSDH with 7 mm of right-to-left midline shift. The patient was taken to the operating room for right-sided craniotomy for subdural hematoma evacuation with placement of IRRAflow irrigating drain in the subdural space. The IRRAflow drain irrigated at 100 cc/h for 23 h with net output consistently greater than irrigation rate. Head CT the following day showed a progressive decrease in subdural collection. The patient was discharged on postoperative day 2 and had complete resolution of his neurological symptoms by postoperative day 11. CONCLUSION As cSDHs become more prevalent in the aging population, development of improved management strategies is imperative. This report describes the use of an IRRAflow dual-lumen catheter with a novel protocol consisting of a high rate of irrigation but net fluid output, which led to rapid recovery and resolution of neurological deficits in a patient with a cSDH.

Patient self-care with double catheter lumen for hemodialization: validation of instructional folder

The use of venous catheters for hemodialysis is associated with high rates of morbidity and mortality in patients with chronic renal failure. The implant of the dual lumen catheter (DLC) assists the patient in a worsening situation but commonly the patient remains with the DLC back home and this requires a series of important measures. The use of printed educational materials becomes an important tool to assist this type of care. Thus, the objective was to create and validate an instructive folder for the self-care of the patient using a catheter for hemodialysis. It is a methodological study of creation and evaluation of technology, in three stages. For validation of the content and style the material was submitted to the evaluation by experts in the area. 92.3% of the participants stated that the folder demonstrates clarity in their language, 53.8% of the participants suggested change and addition of information, and the same percentage also states that the instrument is attractive. The main suggestions were to change some term/word used in the folder, suggest changes to the images used, and include some information in the content. It is presumed then that the use of educational materials results in benefits to the patients who will receive the guidelines for self-care. Thus, the importance of nurses to use these resources for chronic renal patient care is emphasized.