Lumbar Puncture

Question 1

What is lumbar puncture?

Answer 1

Invasive procedure whereby a spinal needle is inserted into the subarachnoid space of the spinal columnn

Question 2

What is the purpose of lumbar puncture?

Answer 2

The purpose is to introduce anaesthetic agent, obtain CSF for diagnostic, examination or therapeutic procedure. The pressure in the spinal column may also be measured

Question 3

What to do during assessment?

Answer 3

Check the patient case note for doctor’s order and the need/reason for LP

Determine the lab test that are ordered

• FEME, protein, glucose, grain stain
• Viral culture, C/S, cell and differential count

1. Identify the right patient
2. Ensure written consent is obtained
3. Determine if patient has any history of clergies to LA or antiseptic solution
4. Perform baseline assessment of the vital signs and neurological status of lower limb, movement, strength and sensation

Question 4

What is the contraindication for LP?

Answer 4

Fundoscopy is usually carried out to exclude increased intracranial pressure.

LP is contraindicated in patient with intracranial space occupying lesson - spinal degenerative joints, coagulopathies and spinal deformities

Question 5

What is the position for LP

Answer 5

Lateral recumbent/ decubitus position with head and neck flexed - preferred position for correct measurement of opening pressure css

Upright seated position only when no opening pressure of CSF measurement is required

Question 6

What are the equipment required for this procedure?

Answer 6

1. Sterile dressing set and sterile drapes
2. 20G/22G quincke needle with stylet
3. Cleansing solution
4. Local anaesthesia with various needles
5. Elastoplast and alcohol wipes
6. Specimen bottles
7. 3 way stopcock and manometer
8. Sterile gloves and gown
9. Protective sheet
10. Sharp box

Question 7

What to do after the spinal needle is removed?

Answer 7

Compress the site with sterile gauze, make sure that the blood oozing stops.

Cleanse the skin if stained and seal the puncture site with adhesive pressure dressing and remove after 24 hours

Instruct patient to lie in supine position for 1 to 6 hours - to prevent post puncture headache (pt can lie with one pillow)

Question 8

What to monitor after procedure?

Answer 8

1. Puncture site - check for seepage of CSF
2. Tolerance (including pain score)
   - pain at site of needle introduction and shooting pain in the lower extremities
   - post lumbar puncture headache (24 to 48hrs after LP)
   - report any numbing and tingling or uninitiated movement of the extremities
3. Monitor CSF results and follow through necessary actions