Intrathecal

Definition

Intrathecal administration is the delivery of medication directly into the subarachnoid space of the spinal canal, allowing drugs to act directly on the CNS and bypass the blood-brain barrier.

Common Uses

• Spinal anesthesia
• Chemotherapy for CNS malignancies (methotrexate, cytarabine)
• Baclofen for severe spasticity
• Opioids for chronic pain

Nursing Considerations

• Only specially trained clinicians administer intrathecal medications
• Verify that the drug is labeled 'for intrathecal use only'. Errors are often fatal
• Maintain strict sterile technique
• Monitor for headache (post-dural puncture), infection (meningitis), neurologic changes
• Keep patient supine (with head of bed flat) after spinal anesthesia/LP to reduce headache risk
• Hydrate and offer caffeine for post-dural puncture headache

NCLEX Relevance

High-alert route. Verify drug and concentration.