The appropriate action
He has a basilar skull fracture and now a slow, clear, watery drip from his right nostril. Clear drainage from the nose after a basilar skull fracture may be cerebrospinal fluid (CSF); it is allowed to drain onto a loose dressing, tested for glucose or a halo sign per protocol, and reported. Letting it drain onto a loose pad and reporting it is the appropriate action.
Why CSF leaks occur and why they matter
A fracture of the skull base can tear the dura mater, creating a connection between the subarachnoid space and the nasal cavity or middle ear. CSF then leaks from the nose (rhinorrhea) or ear (otorrhea). This open pathway also allows bacteria from the nose to travel inward, so the main danger is meningitis. Most small leaks seal on their own as the dura heals, provided the pathway is not disturbed. Testing helps confirm the fluid: CSF contains glucose, unlike normal nasal mucus, and blood-tinged CSF on a gauze pad may form a halo, a clear ring around a central blood stain.
| Action | Effect | Verdict |
|---|
| Pack the nostril | Blocks drainage; traps fluid that can carry infection inward | Avoid |
| Suction the nostril | Can introduce infection; nasal tubes avoided | Avoid |
| Blow the nose | Pushes organisms inward; raises intracranial pressure | Avoid |
| Loose pad, test, report | Free drainage; confirms CSF; alerts provider | Correct |
Why the other actions are wrong
Packing the nostril blocks the drainage and traps fluid that can carry infection toward the brain. Nasal suctioning and nasal tubes are avoided when a basilar skull fracture is suspected, because they can introduce infection and, rarely, enter the cranial vault through the fracture. Blowing the nose can push organisms inward and also raises intracranial pressure. Packing, suctioning, nasal tubes, and nose-blowing are all avoided because they raise the risk of infection reaching the brain.
Nursing care
The nurse places a loose pad under the nose, records the amount and character of the drainage, keeps the head of the bed elevated as ordered, teaches the client not to blow his nose, sneeze forcefully, or strain, and monitors for fever, neck stiffness, headache, or changes in level of consciousness that could suggest meningitis.
Exam takeaway
Key point Clear nasal or ear drainage after a basilar skull fracture is CSF until proven otherwise: let it drain freely, test per protocol, and report. Never pack, suction, or blow the nose.