-Chiqui ValdezSMCQC NCM 1o4

• a.k.a ‍ Spinal Tap ‍ Ventricular Puncture ‍ Lumbar Puncture ‍ Cerebral spinal fluid culture

Definition:
• Cerebral spinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. Cerebral spinal fluid acts like a cushion, protecting the brain and spine from injury. • Is an insertion of a needle between the L3-L4 or L5 and cerebrospinal fluid is withdrawn for diagnostic and therapeutic purposes.

CSF (cerebrospinal fluid )
• a clear fluid produced by the choroid plexus in the ventricles of the brain that bathes the brain and spinal cord giving them support and buoyancy to protect from injury. This fluid is produced in the ventricles of the brain and circulates through the subarachnoid space (the space between the pia and arachnoid mater of the brain and spinal cord).

More specifically, the CSF occupies the space between the arachnoid mater (the middle layer of the brain cover, meninges) and the pia mater (the layer of the meninges closest to the brain). It constitutes the content of all intra-cerebral (inside the brain, cerebrum) ventricles, cisterns and sulci (singular sulcus), as well as the central canal of the spinal cord.

This procedure is done…

…. to measure pressures within the cerebrospinal fluid and to collect a sample of the fluid for further testing. CSF can be used to diagnose certain neurologic disorders, particularly infections (such as meningitis) and brain or spinal cord damage.


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to collect CSF for testing to detect disease conditions

to measure CSF pressure to detect hydrocephalus to deliver contrast dye to the spinal canal during diagnostic imaging to deliver anesthetic numbing agents to the spinal cord as a treatment to relieve hydrocephalus during brain surgery to control CSF pressure and relax the brain

Materials & Equipments needed Spinal needle Sterile gauze
(size 22 or 24) Sterile gloves

Antiseptic solution

Mask (optional)

Mid open sheet/eye sheet/fenestrated drape CSF kit/tray

Sterile specimen containers

Anesthetic agents

Manometer to measure spinal fluid pressure

Procedure:

The patient must lay on his or her side, with the knees pulled up toward the chest, and the chin tucked downward. Sometimes the test is done with the person sitting up, but bent over.

After the back is cleaned, the health care provider will inject a local numbing medicine-anesthetic (Bupivacaine,Lidocaine, tetracaine, procaine, ropivacaine, levobupivicaine and cinchocaine) into the lower spine.

A spinal needle is inserted, usually into the lower back area. (between the L3-L4 or L5 )

Once the needle is properly positioned, spinal fluid pressure is measured, and fluid is collected (between 5 - 20 ml of cerebrospinal fluid in 2 to 4 tubes ).

The needle is removed, the area is cleaned, and a bandage is placed over the needle site. The patient is often asked to lie down (dorsal recumbent/supine position) for a short time after the test.

• A successful lumbar puncture requires that the patient be relaxed, an anxious patient which is tensed, may increase the pressure reading. • The CSF should be clear and colorless. Pink, blood tinged, or grossly bloody CSF may indicate a cerebral confusion, laceration or subarachnoid hemorrhage

Normal Values:
Pressure: 50 – 180 mm H20 Appearance: clear, colorless CSF total protein: 15 - 45 mg/100 mL Gamma globulin: 3 - 12% of the total protein CSF glucose: 50 - 80 mg/100 mL (or approximately 2/3 of blood sugar level) CSF cell count: 0 - 5 white blood cells, no red • blood cells Chloride: 110 - 125 mEq per liter • • • • • •

Normal results
Appearance:

CSF is normally clear and colorless. Normal CSF pressure in the lower back for an adult ranges from 50–180 millimeters (mm) water. For children, the normal opening pressure range is 10–100 mm water. The normal protein content of CSF in an adult's lower back (lumbar) region is 15–45 milligrams per deciliter (mg/dL) or less. Older adults and children may have higher values (up to 70 mg/dL) that are still in the normal range.

Pressure:

Protein:

Glucose:

The normal range for glucose content in the CSF is at least 40%–80% of the blood glucose level. The levels may be slightly increased if the person has just eaten.

Cell counts:

Normal CSF contains no red blood cells (RBCs). The white blood cell (WBC) count for adults is 0–10 WBCs per cubic millimeter (mm3). Children may normally have a higher WBC count. No neurophils are present. Lymphocytes or monocytes are 0–4 per mm3.

Other results: No infectious organisms (such as bacteria, fungi, or a virus) are found in the CSF sample. No tumor cells are present.

Abnormal results
Appearance:

Blood in the CSF can result from bleeding (hemorrhage) in or around the spinal cord or brain, but it may also be caused by tiny blood vessel poked during the spinal tap. If a brain hemorrhage has occurred, the color of the CSF may change from red to yellow to brown over several days. Bleeding caused by the lumbar puncture itself will show more red blood cells in the first sample collected than in later samples. Cloudy CSF may mean an infection (such as meningitis or a brain abscess) is present. High CSF pressure may occur as a result of swelling (edema) or bleeding (hemorrhage) in the brain, infection (such as meningitis), stroke, or other circulatory problems. Below-normal pressure may mean a blocked spinal canal. A high level of protein may be caused by bleeding in the CSF, a tumor or spread of a cancer from another area of the body, diabetes, infection, injury, Guillain-Barré syndrome, severe hypothyroidism, or other nerve diseases. An increase in antibodies (immunoglobulins) may be caused by inflammation in people who have multiple sclerosis, immune system disorders, or other bacterial and viral diseases. Low glucose levels in the CSF are abnormal and may be caused by bacterial meningitis. Viral meningitis does not often cause low glucose levels in the CSF. Brain hemorrhage may also cause low glucose levels several days after bleeding begins. Higher-than-normal glucose levels are often caused by diabetes. Red blood cells (RBCs) in the CSF means bleeding. High levels of white blood cells (WBCs) mean meningitis. Tumor cells and abnormal levels of white blood cells mean cancer.

Pressure:

Protein:

Glucose:

Cell counts:

Other results: Antibodies, bacteria, or other organisms in the CSF means that an infection (such as syphilis) or disease is present. Bacterial markers (bacterial antigens) that show up mean meningitis. Cultures or stains of the CSF may also help show the cause of meningitis or encephalitis.

Risks:
-----Risks of lumbar puncture include: • Hypersensitivity (allergic) reaction to the anesthetic • Discomfort during the test • Headache with nausea • Paresthesia (sensation of tingling, pricking, or numbness of a person's skin with no apparent long-term physical effect. It is more generally known as the feeling of "pins and needles" or of a limb being "asleep" ) • Spinal or epidural bleeding • Trauma to the spinal cord or spinal nerve roots • Weakness • Loss of sensation • Paraplegia • Perforation of abnormal dural arterio-venous malformations • Infection • Spinal cord compression

Considerations:
• This test should not be performed on people who have lesions that cause increased intracranial pressure. Others who should not have this test include patients with: -Blood clotting problems -Thrombocytopenia -Risk of infection

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