A patient has clear drainage from the nares after transsphenoidal hypophysectomy. Which action is essential?

A patient has clear drainage from the nares after transsphenoidal hypophysectomy. Which action is essential?

• A. Lower the head of the bed
• B. Test the drainage for glucose
• C. Obtain a culture of the drainage
• D. Continue to observe the drainage

Answer: (B)

Clear nasal drainage after this type of pituitary surgery can be cerebrospinal fluid leaking from the operative site. The essential step is to test the drainage for glucose because CSF contains glucose, whereas normal nasal secretions do not. A positive glucose test on the drainage strongly suggests a CSF leak, which must be reported to the surgeon promptly and managed to protect the repair and reduce the risk of meningitis. Other actions don’t confirm a CSF leak or protect the patient as effectively: simply observing the drainage won’t distinguish CSF from mucus, culturing it won’t confirm CSF presence, and changing head position won’t address the diagnostic need and could impact recovery.

Clear nasal drainage after this type of pituitary surgery can be cerebrospinal fluid leaking from the operative site. The essential step is to test the drainage for glucose because CSF contains glucose, whereas normal nasal secretions do not. A positive glucose test on the drainage strongly suggests a CSF leak, which must be reported to the surgeon promptly and managed to protect the repair and reduce the risk of meningitis. Other actions don’t confirm a CSF leak or protect the patient as effectively: simply observing the drainage won’t distinguish CSF from mucus, culturing it won’t confirm CSF presence, and changing head position won’t address the diagnostic need and could impact recovery.