Lumbar puncture

Question 1

Lumbar puncture indications

Answer 1

Aid in diagnosis of infection, inflammation, oncologic and metabolic processes
therapeutic indications include the delivery of chemotherapy, antibiotics and anesthetics

Question 2

Lumbar puncture contraindications

Answer 2

patients with cardiopulmonary compromise
patients with signs of cerebral herniation
patients with coagulopathys
patients with previous lumbar surgery

Question 3

Lumbar puncture positioning

Answer 3

Lateral recumbent position (preferred) or sitting position.
the patient should adopt the fetal position and arch like a car with his or her back flexed to widen the gap between the spinous process.

Question 4

Lumbar puncture landmarks

Answer 4

draw a line between the superior aspects of the iliac crests that intersects the midline at the L4 spinous process. Insert the needle in the interspace between the L3,L4 or L4,L5.

Question 5

LP needle insertion angle

Answer 5

15degrees cephalad, as if aiming for the umbilicus

Question 6

LP puncture bedrest … decrease the incidence of headaches after LP

Answer 6

does not

Question 7

LP complications

Answer 7

herniation
cardiorespiratory compromise
local or referred pain 
headache
bleeding
infection
subarachnoid epidermal cyst CSF leakage

Question 8

Most common LP complication

Answer 8

headache, occurs within 36.5% of patients within 48 hours after procedure

Question 9

The most serious LP complication

Answer 9

Herniation

Question 10

What size of needle for an LP?

Answer 10

A 22 gauge needle preferred because this will decrease the risk of CSF leakage