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Introduction: The cerebrospinal fluid is formed through the chorio villi, in each of the four ventricles of the brain and it circulates freely
through the ventricles , the subarachnoid space and the central canal of the spinal cord . It is then absorbed into the venous circulation via
superior sagittal sinus.
During development the vertebral column outgrows the spinal cord. In adult, the spinal cord ends at the lower border of the first lumber vertebra;
but in the newborn infant it ends slightly at the lower level at the level of the third lumber vertebra . the dural and arachnoid sacs extends up to the
level of the second sacral vertebra and is cavity the CSF. Thus the region between the second lumber vertebra and the second sacral vertebra is
suitable for the withdrawal the CSF , as there is no danger of injury to the spinal cord.
Definition: A lumber puncture is the insertion of a needle into the lumber region of the spine, in such a manner that the needle enters the
lumber arachnoid space of the spinal canal below the level of the spinal cord , so that the cerebrospinal fluid can be withdrawn or a substance can
be therapeutically or diagnostically injected.
Patient Positioning
Sitting
This position generally makes it easier to identify anatomical landmarks and planes.
Sit the patient on a firm surface.
Patient should lean forward, and can hug a pillow on a table at the right height to flex (not extend) the back.
Lift the patient’s legs by putting their feet on a stool or chair and flex the hips to above 90 degrees.
If pressure measuring is required, lie the patient on their side (after successful needle insertion) with assistance and then
open the tap to measure the pressure.
Lying down
Postioning correctly is all about increasing the interspinous distance as much as possible.
Preparation of Articles:
A sterile tray containing:
LP needles- 2 sizes with the their stilette.- to aspirate the fluid
Sponge holding forceps.-to clean the area of body
Syringes ( 5ml) with needles to give anaesthesia.-to give anesthesia
Small bowl- to take cleaning lotion.
Specimen bottle-to collect the fluid
Cotton balls, gauze pieces and cotton pads- to cover the the puncture area
Gloves , gown and masks-to maintain the aspectic technique
Dressing towels or slit towel- to maintain the aspectice technique
Three way adapter , manometer and tubing to measure the pressure of the CSF if required.
An unsterile tray containing:
Mackintosh and towel.
Kidney tray and paper bag.
Spirit , Iodine, tr. Benzoin, etc
Lignocaine 2 percent
Sterile normal saline to fill in the manometer.
Adhesive plaster and scissors.
.Instructions:
STEPS OF PROCEDURE
o The patient sits down on the edge of the table or lies down on the side, with the knees drawn up
to the chest.
o The doctor marks the area, where the puncture will be made (with a pen)
o The area is cleaned with some soap, before being draped with a sterile towel
o Anesthesia is applied on to the skin
o A long and thin needle is inserted in the spinal canal and the stylet is removed so that the fluid is
o collected. In some cases, the doctor may need to move the needle farther in or at a different
angle, to get the fluid in the spine.
o A device known as a manometer is connected to the needle, to measure the pressure of the fluid.
Patients who are lying down may be asked to straighten their legs at this point.
Once the fluid is collected, the final pressure reading is taken, the needle is removed and the site of
the puncture is cleaned and bandaged.
The samples of the fluid are collected, they are sent to a lab, to check for any abnormalities.EDURE
After care of the procedure:
As soon s the needle is withdrawn , Seal the puncture site to prevent leakage of CSF.
Place the child comfortable on the bed in a supine position for 12 to 24 hours.
If the patient develops post puncture headache , The following precaution are taken.
Darken the room.
Give plenty of oral fluids .
Administered analgesics.
Raise the foot end of the bed.
Watch for Patient’s color, Pulse , respiration, blood pressure and other signs of complication.
Record the procedure on the patient’s charts with date and time.
The specimens of CSF collected should be sent to the laboratory without any delay with proper labels
and requisition.
If there are no complication observed , the patient may be allowed to be upright after 8-12 hours.
NURSING DIAGNOSIS -:
Acute pain related to lumber puncture as evidence by the verbalization of the patient
Impaired physical mobility related to puncture as evidence by less movements.
Risk for infection related to surgical procedure.
NURSING RESPONSIBILITY
Assess the condition of the patient .
Give the comfortable position to reduce the pain
Administer the analgesics as prescribed by doctor
Give the information regarding the procedure and reduce the anxiety by introducing with other
patient who had undergone the same procedure
Advice the patient to take small walks after the few hours of the procedure
Maintain the aseptic techniques during and after procedure .
BIBLIOGRAPHY
Ansari Javed, Comprehensive Medical Surgical Nursing ,published by Pee Vee, 2011 edition , page no-
573-586.
Suddarth’s & Brunner , textbook of medical surgical nursing , published by Lippincott Williams &
Wilkins , 11 edition, page no-853
Black M Joyce; Medical-Surgical Nursing; vol-II; Elsevier; 7th edition; pge no.- 1335-1355.