The interspace is selected after palpation of the spinous processes at each lumbar level. Once the area for needle insertion has been ascertained, the examiner puts on a mask and sterile gloves — this decreases the risk of infection. The skin is then cleansed with alcohol and usually an iodine based disinfectant and the area is draped with a sterile cloth. The lumbar puncture needle is typically a 20 — 22 gauge needle and it is inserted into the target area and slowly advanced.
The bevel of the needle is maintained in a horizontal position with the flat portion of the bevel pointing up and it should be parralel to the direction of the dural fibers. Once a subarachnoid space has been reached, a manometer can be attached to the needle to record the opening pressure. Fluid is then usually obtained for collection. Fifteen millilitres of CSF is usually sufficient for a sample. The fluid is then taken and may be analysed for a number of parameters according to the clinical presentation including:.
The minor risks and complications associated with a lumbar puncture include backache, post lumbar puncture headache , radicular pain and numbness. Major complications that rarely occur include infection, haemorrhage, damage to the spinal cord or nerve roots and herniation of cerebral tissue in patients with pre-existing increased intracranial pressure.
View more information about myVMC. Please be aware that we do not give advice on your individual medical condition, if you want advice please see your treating physician.
Parenting information is available at Parenthub. A lumbar puncture is only done in this condition after evaluation and head imaging. Normal pressure hydrocephalus. A rare condition affecting mainly older people in which there is a triad of loss of urinary control, memory problems, and an unsteady gait. A lumbar puncture is done to see if the pressure of the CSF is elevated or not.
In addition, a lumbar puncture may be used to measure the pressure of the CSF. The healthcare provider uses a special tube called a manometer to measure s the pressure during a lumbar puncture.
Finally, a lumbar puncture may be done to inject medicine directly into the spinal cord. These include:. Your healthcare provider may have other reasons to recommend a lumbar puncture. Because this procedure involves the spinal cord and brain, the following complications may occur:.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.
I f you are having a lumbar puncture at Johns Hopkins Hospital or Bayview Medical Center, a neuroradiologist or radiology nurse will contact you by phone two or three days prior to your lumbar puncture to discuss the procedure and answer any questions you may have.
Please inform the neuroradiology physician if:. Other options should be discussed with you and your doctor. A gown will be provided for you. However, the procedure may also be done while you remain in your clothes from home.
For this reason, try to wear non-restrictive, comfortable clothing and slip on shoes if possible. Please remove all piercings and leave all jewelry and valuables at home. If you are not sure if it is safe for you, contact your primary care provider or referring provider.
However, on the day of the procedure, do not eat for three hours before the procedure. You may have liquids and can take your usual medications unless previously advised to hold certain medications in preparation for the lumbar puncture. Please bring a current list of your medications and allergies with you.
This is for your safety and comfort. A lumbar puncture procedure may be done on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices. Some healthcare providers may prefer to do this procedure at the bedside or may opt to have it done using a type of live X-ray called fluoroscopic guidance.
You may have discomfort during a lumbar puncture. Your healthcare providers will use all possible comfort measures and complete the procedure as quickly as possible to minimize any discomfort or pain. This helps reduce the incidence of a headache. You will be allowed to roll from side to side as long as your head is not elevated. If you need to urinate, you may need to do so in a bedpan or urinal during the time that you need to stay flat.
You will be asked to drink extra fluids to rehydrate after the procedure. This replaces the CSF that was withdrawn during the spinal tap and reduces the chance of developing a headache. After recovery, you may be taken to your hospital room or discharged to your home. If you go home, usually your healthcare provider will advise you to rest for the remainder of the day.
When the manometer has emptied, remove the manometer. In numerical sequence, allow about 1 to 2 mL of CSF to drip into each of the 4 collection tubes. Greater volumes up to 30 to 40 mL may be useful for some tests, such as detection of acid-fast bacilli, fungi eg, Cryptococcus neoformans , Coccidioides immitis , or carcinomatous meningitis. Do cell count and differential on the 1st and 3rd tubes so that counts can be compared if red blood cells are present. A sharp decrease in red blood cell count from the 1st to the 3rd tube is consistent with a traumatic puncture.
Consider freezing the 4th tube in case additional, unanticipated studies later become necessary. Check with the lab to see how long it holds specimens, and ask them to hold the sample for a longer period of time if needed.
Bedrest after lumbar puncture is unnecessary and does not reduce the incidence of post-lumbar puncture headache; however, recumbency remains helpful in treating post-lumbar puncture headache. Increased oral intake of fluids has been suggested to treat post-procedural headache but has not been effective in controlled trials. Caffeine may help prevent post-procedural headache.
Instruct the patient to be vigilant for persistent or worsening back pain may occur up to several days after the lumbar puncture , which requires prompt evaluation to exclude or hematoma.
When using the lateral decubitus position, maintain the patient's tightly curled fetal position. If the spinal canal is not entered, do not try to reposition the needle by moving the tip to one side or another; this can damage tissue. Instead, withdraw the needle nearly to the skin surface ie, outside of the spinal ligament before changing the angle and direction of insertion. Seat yourself comfortably close to the patient before doing the procedure in the lateral decubitus position.
Avoid inserting the lumbar puncture needle through tattooed skin because of a theoretical possibility that tattoo ink could be introduced into the CSF and cause irritation or toxicity. If necessary, either use an adjacent interspace or make a small stab incision through the tattooed epidermis with a scalpel and then introduce the needle through the incision.
After the needle is through the skin and into the spinous ligament, recheck the patient's alignment hips perpendicular to bed and direction of the needle perpendicular to spine before inserting further. Draw blood to measure glucose level before eg, by up to 30 minutes lumbar puncture so that level can be accurately compared with the CSF glucose level.
With this timing, serum and CSF oligoclonal bands can be compared also. If lumbar puncture is unsuccessful in the decubitus position, try the sitting position, which may be successful because of increased spinal flexion and intervertebral space opening.
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Absolute contraindications. Lower back discomfort or pain that may radiate to the posterior legs self-limited. Sterile gloves, gown, face mask, and cap. Bedside ultrasound device with a high-frequency linear array probe. Identify and prepare the site Place the patient in proper position, using an assistant if needed.
For children, apply topical skin anesthetic and allow time for it to take effect. Place sterile equipment on a sterile equipment tray and cover with a sterile drape. Ensure smooth working motion of the stopcock and of the spinal needle and stylet.
Palpate the iliac crest and spinous processes to reconfirm the insertion site. Lumbar puncture This lumbar puncture is done with the patient in the lateral decubitus position and the lumbar puncture needle inserted at the L3-L4 interspace. Remove the stylet from the spinal needle. Never aspirate CSF fluid. Reinsert the stylet into the needle.
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