ASSIGNMENT

ON
LUMBAR PUNCTURE

SUBMITTED TO: SUBMITTED BY:

Mrs. M.Jothimalar .M.sc nursing Mrs. N. Anantha packiam
Associate Professor M.Sc Nursing I St Year
Department Of MSN Rass Academy College Of
RACN, Madurai.. Nursing, Madurai
 LUMBAR PUNCTURE
INTRODUCTION:
A Lumbar Puncture is the insertion of a needle into the lumbar
region of the spine; in such a manner that the needle enters the lumbar arachnoid
space of the spinal canal below the level of the spinal cord. So that the
cerebrospinal fluid (C.S.F) can be withdrawn or substance can be therapeutically
or diagnostically injected.
The cerebrospinal fluid is formed through the choroid villi, in each
of the four ventricles of the brain and circulates freely through the ventricles, the
subarachnoid space and the central canal of the spinal cord. It is then absorbed
into the venous circulation via superior sagittal sinus. By this arrangement, the
delicate nerve matter of the brain and the spinal cord, and the external layer of
fluid in the central of the spinal cord, and the external layer of fluid in the
subarachnoid spaces surrounding the brain and the spinal cord.
During development, the vertebral column outgrows the spinal cord. In
adult the spinal cord ends at the lower border of the first lumbar vertebra; but in
the new born infants it ends slightly at the lower level i.e at the level of the third
lumbar vertebrae. The epidural and arachnoid sacs extends up to the level of the
second sacral vertebrae and this cavity contains the CSF. Thus the region between
the second lumbar vertebrae and the second sacral vertebra is suitable for the
withdrawal of CSF, as there is no danger of injury to the spinal cord.
DEFINITION:
Aspiration or withdrawal of cerebrospinal fluid (CSF) by inserting
the LP needle into 3rd/4th lumbar subarachnoid space.
PURPOSE OF THE LUMBAR PUNCTURE:
1. To administer spinal anesthesia before surgery in the lower half of the
body.
2. To administer medication into the spinal canal as in the case of meningitis.
3. To remove fluid (CSF, blood pus etc.) contained in the subarachnoid
space, thereby reduce the intracranial pressure, if it is dangerously high.
4. To remove a sample of CSF for laboratory examinations in order to
diagnose disease.
5. To measure the pressure of CSF and to determine whether the lumbar
subarachnoid space is in communication with the ventricles of brain.
 6. To remove CSF and to replace it with air, oxygen or radio-opaque
substances for diagnostic X-ray (pneumo- encephalography, myelography
etc.) in order to locate tumors or other brain disorders.
EQUIPMENT:
1. LUMBAR PUNCTURE SET CONTAINING:
 Dressing cup (2) with cotton balls and gauze pieces
 Dressing forceps (1)
 Specimen bottles
 Surgical towel (1)
 Biopsy towel (1)
 Lumbar puncture needle
 Syringes (10 cc, 5cc)
 Needles ( 22G,23G, 24G)
 K-basin
2. INJECTION TRAY WITH:
 Antiseptic spirit
 Tincture benzoin
 Lignocaine 2% (local anesthetic)
3. OTHER -EQUIPMENT:
 Gloves
 Gown
 K-basin
 Mask
SITE OF LUMBAR PUNCTURE AND THE POSITIONING OF THE
CLIENT:
 Since the spinal cord ends at the level of the first lumbar vertebra
and the subarachnoid space extends up to the second sacral vertebra,
any site between these two points may be used for the puncture of
the spine.
 In adults the site of the lumbar puncture is usually between the
second third or fourth and fifth lumbar vertebrae. In small children
and infants, the site is still lower because the spinal cord extends up
to the third lumbar vertebra. These sites are safe to prevent injury to
the spinal cord.
POSITION AND TECHNIQUE FOR LUMBAR PUNCTURE- ADULT:

 The client is placed in side lying position (right or left according to the
doctor’ convenience) at the edge of the table or bed.
 The client ‘s body should be fetal attitude ‘C’ shaped with full flexion of
the spine. The back should be vertical to the bed and with no lateral flexion
of the spine. The client is asked to draw both knee up towards the chin.
 The head and neck are flexed and bought towards the chest. In order to
maintain this position, the client may keep both his hands between the
knees. In this position the intervertebral spaces are widened and the needle
can be easily inserted. If the client is not able to maintain this position, the
nurse helps him. The nurse stand in front of the client and keeps one hand
behind the knees and the other hand behind the neck and tries to bring the
client into the desired position.

 POSITION AND TECHNIQUE FOR LUMBAR PUNCTURE -CHILD:

NURSING ACTION RATIONALE

Explain the procedure To remove fear and anxiety
1.Collect equipment near patients bed side.
2.Bring child to treatment room and position
child in right or left lateral position convenient to
the doctor with knees drawn to chest as in fetal
position. Help required in holding the child in
position(young children : hold the child with one
arm behind the neck and the other behind the
thighs to maintain child’s spine in flexed
position)
3.Open LP set. Proper positioning facilitates the flow
of CSF
A) Place the sterile towel at lumbar region
and the site. 3rd or 4th lumbar space is
identified.
B) Assist doctor to clean site with antiseptic
and to administer local anesthetic.
C) Divert child from fear and pain.
D) Doctor inserts needle into specific site and
allows CSF to drain freely into specimen
bottle taken from LP set.

4. Area is sealed with tincture benzoin after A) Contamination of the sterile field
needle is withdrawn. can predispose to central nervous
system infections.
 B) Minimizes CSF leak.
5.Monitor vital signs and general sensorium for
serious complication of brain herniation.
6.Shift the child to the bed.
7.Ensure that the child rests at least for 4 to 6 Minimizes cerebrospinal fluid leak
hours
8.Replace articles.
9.Monitor vital signs half hourly for six hours, or
until stable.
10.Send labeled specimens to lab, with
investigation slips.
11.Replace equipment after rinsing.
12.Document time, procedure, condition of
child, any adverse reactions, amount of CSF
taken and specific lab to which specimen has
been sent.
13.Assess for neurological symptoms like loss of Enhances early identification and
sensorium, headache, nausea, vomiting, prevention of complication such as
weakness, and loss of sensation in lower meningitis, which can increase the
extremities for motor activity, leakage of CSF. intracranial pressure.

AFTER CARE OF THE CLIENT:

 As soon as the needle is withdrawn, seal the puncture site to prevent
leakage of CSF.
 Place the client comfortably on the bed in a supine position. He should be
asked to lie down flat on bed for 12 to 24 hours.
 If the client develops post puncture headache, the following precautions
are taken:
(a) Darken the room.
(b) Give plenty of oral fluids to re-establish the CSF level.
(c) Administer analgesics.
(d) Raise the foot end of the bed.
 The client should be watched constantly for several hours after reported
immediately. Watch for client’s color, pulse, respiration, blood
pleasure and other signs of complications such as nausea vomiting
headache etc.
 Record the procedure on the client’s chart with date and time. Record
the amount and character of the fluid with drawn, the pressure of the
CSF measured, client’s general conditions, any untoward reaction such
 as nausea, vomiting, headache etc. developed in the post procedure
period.
 The specimens of CSF collected should be sent to the laboratory
without any delay with proper label and a requisition form.
 If there are no complications observed, the client may be allowed to be
upright after 8 to 12 hours.
COMPLICATIONS:
 Injury to the spinal cord and spinal nerves.
 Infection introduced into the spinal cavity which may give rise to
meningitis.
 Leakage of CSF through the puncture site and lowering the intra-
cranial pressure and may cause post puncture headaches.
 Damage to the intervertebral disc.
 Local pain, oedema and hematoma at the puncture site.
 Temperature elevation.
 Rapid reduction in the intracranial pressure caused by the removal
of CSF can cause herniation of the brain structures into the foramen
magnum. This is turn cause pressure on the vital centers in the
medulla causing respiratory failure and sudden death. (LP is
contraindicated in case of Intracranial tumors.)
 Pain radiating to the thighs due to trauma of the spinal nerves.
BIBLIOGRAPHY:
 www.google.com
 www.slideshare.net