NCM 109 SKILLS LABORATORY FGVGBBB TT5Y__________
LUMBAR PUNCTURE
o Maximally flex spine without compromising
LUMBAR PUNCTURE airway.
- Also called Lumbar Tap or Spinal Tap. o Keep alignment of feet, knees and hips.
- A procedure where a needle is inserted in your o Position head to left if right handed or vice
back and into the spinal canal. versa.
- This is done to collect cerebrospinal fluid (CSF) or
treat certain medical conditions.
Purposes:
• To obtain CSF for analysis and diagnosis of: PROCEDURE
o Meningitis Pre-Procedure:
o Meningoencephalitis 1. Obtain a written consent for the procedure.
o Subarachnoid hemorrhage 2. Explain the procedure.
• To drain CSF and reduced intracranial space 3. Determine whether the patient have any
• To instill medications doubts or misconceptions.
• To measure the pressure of CSF 4. Instruct px to avoid after the procedure.
Contraindications:
• Increased intracranial pressure
Procedure:
• Head CT before study if focal neurologic findings
5. Position the px at one side of the bed.
present to rule out impending cerebral mass 6. Place a small pillow under px’s head and
herniation. another b/w the legs.
• If platelet count is less than 40,000 and prothrombin 7. Assist the px to maintain position.
time is less than 50% of control. 8. Encourage px to relax and to breathe
EQUIPMENT: normally.
● Sterile CSF tray ● 25G needle and 9. The physician cleanses the site with antiseptic
● Spinal needle syringe solution and drapes the site.
● Anesthetic such as: ● Povidone-iodine 10. Local anesthetic is injected to numb the site.
o Xylocaine cream solution 11. A spinal needle is inserted to subarachnoid
o Lidocaine 1% ● Sponge space with stylet bevel up.
● Manometer ● Drapes 12. Stabilize the 20 or 22 gauge needle with index
● Stopcock ● Gauzes fingers, and advance it through the skin wheal
● Tubing ● Bandage using the thumbs.
● Specimen Bottles 13. Orient the bevel parallel to the longitudinal
Reminders: dural fibers to increase the chances that the
• Use smallest possible gauge (20 or 22) needle will separate the fibers rather than cut
• Prefer atraumatic rather than cutting needle them.
o 1.5 inches for less than 1 year old 14. In the lateral recumbent position, the bevel
o 2.5 inches for 1 year to middle childhood should face up.
15. In the sitting position,
o 3.5 inches for older children and adolescents
it should face to one
o Larger for adults
side or the other.
16. Collect at least 10
drops of CSF in each
of the 4 plastic tubes,
starting with tube 1.
17. If possible, the CSF
that is in the
• Position of the patient:
manometer should
o Spinal cord ends at L1-L2, so sites for puncture be used for tube 1.
are located at L3-L4 or L4-L5. 18. If the CSF flow is too
slow, ask the px to cough or bear down (as in
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NCM 109 SKILLS LABORATORY FGVGBBB TT5Y__________
LUMBAR PUNCTURE
the Valsalva maneuver), or ask an assistant to
press intermittently on the px’s abdomen to
increase the flow.
19. Alternatively, the needle can be rotated 90° so
that the bevel faces cephalad.
20. For measurement of the opening pressure, the
px must be in the lateral recumbent position.
21. After fluid is returned from the needle, attach
the manometer thru the stopcock, and note
the height of the fluid column.
22. The px’s legs should be straightened during the
measurement of the open pressure, or falsely
elevated pressure will be obtained.
23. Insert the needle at a slightly cephalad angle,
directing it toward the umbilicus.
24. Advance the needle slowly but smoothly.
25. Occasionally, a characteristic “pop” is felt
when the needle penetrates the dura.
26. Otherwise, the stylet should be withdrawn after
approximately 4-5cm and observed for fluid
return.
27. If no fluid is returned, replace the stylet,
advance or withdraw the needle a few mm,
and recheck for fluid return.
28. Continue this process until fluid is successfully
returned.
Complications:
• Headache
• Back pain (occasionally with short-lived)
• Disc herniation if needle advanced too far
• Bleeding or fluid leak around spinal cord
• Infection, pain, hematoma
• Subarachnoid epidermal cyst
• Nerve trauma
• Brainstem herniation
Management:
• Bed rest
• Analgesics
• Hydration
• Epidural blood patch
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