A patient arrives postoperatively with clear fluid present on the lumbar dressing. Which action should be performed first?

• A. Test the fluid for glucose
• B. Discard the dressing and apply a new one
• C. Administer prophylactic antibiotics
• D. Document without further assessment

Answer: (A)

A postoperative clear fluid on a lumbar dressing can indicate a cerebrospinal fluid leak, which is a serious complication to identify quickly. The best first action is to test the drainage for glucose because CSF contains glucose, whereas typical wound drainage does not. A positive glucose test supports that the fluid is CSF, which then prompts immediate communication with the surgical team and initiation of appropriate precautions to protect the patient from infection and to plan further management. Discarding the dressing, giving prophylactic antibiotics without confirmation, or simply documenting without assessing would not address the potential CSF leak and could put the patient at risk.