LUMBAR PUNCTURE

Lumbar puncture also known as spinal tap, a needle is inserted into the sunarachnoid space in the lumbar region of the spine below the level of the spinal cord. CSF can be withdrawn or subatances can be injected into this space. DEFINITION Assisting in aspiration of cerebrospinal fluid (CSF) from sub arachnoid space (Lumbar cistern) by puncturing the space between spinous processes of L3 and L4 or L4 and L5, using aseptic technique. PURPOSES         To determine CSF pressure. To introduce drug intrathecally. To do myelogram. To give spinal anesthesia. To analyze CSF constituents. To help in diagnosis. To detect spinal subarachnoid block. To examine for pathogenic organisms and blood.

EQUIPMENTS A dressing trolly with the following equipments: 1. Injection tray with: a) Tincture benzoin b) Spirit c) Iodine d) Lignocaine/ Xylocaine 2% e) 5cc or 2cc syringe f) 20G, 22G needles 2. Lumbar puncture set containing: a) A tray with b) Dressing cup (2) with cotton balls and gauze pieces c) Dressing forceps 1 d) Specimen bottles 1 e) Surgical towel 1 f) LP needle 1 g) Manometer (if pressure has to be measured) 3. Other equipments:

reassure that the needle will not enter the spinal cord and cause paralysis. 8 to 10 ml may be removed. PROCEDURE The patient is positioned at one side of the bed with back towards the physician. 2 to 3ml of CSF is collected in each tube. Observe for headache. The physician applies a small dressing on the puncture site to prevent the leakage of CSF fluid. nausea.  A written consent has to be taken from the patient.  Maintain q ½ h pulse and respiration for 4-5 hours till stable. POST-PROCEDURE CARE  Instruct the patient to lie in prone position for 2-3hours. The physician injects local anaesthetic to numb the site and inserts the needle through the third and fourth or fourth and fifth intercostal space.  Assemble the necessary equipment in the client¶s room. The nurse should describe step by step procedure to the patient as it proceeds.  Instruct the patient to empty bladder and bowel before the procedure. Sudden change in the position can cause traumatic injury to the spinal cord.  Monitor the patient for complications of lumbar puncture.  Replace equipments after rinsing. notify the physian in cases of complications. A specimen CSF is collected in test tubes and labelled. and loss of sensation or movement in lower limbs. The nurse should assist the patient in maintaining the position. The physician cleanses the site and drapes.  Determine whether the patient has any misconceptions about the procedure. the thighs and legs are flexed as much as possible to increase the space between the spinous process of the vertebrae.  Label specimen and sent to lab with investigation slips.a) Gloves b) Mask. for easier entry into the subarachnoid space. A pillow is placed between the legs to prevent the upper leg from rolling forward. and the client¶s role during the examination. vomiting. PRE-PROCEDURE CARE  Educate the client and the family about the purpose of LP. what the client will feel.  Encourage to increase the fluid intake to prevent post procedure headache. . The patient is asked to relax and breathe normally to prevent hyperventilation. The tubes are sent immediately to the labrotory.  Check the puncture site frequently for CSF leakage. The needle is withdrawn. In addition have laboratory request forms available and a marking pencil to label the samples of spinal fluid. A small pillow is placed under the patients head to maintain the spine in horizontal position.

2. Indore. B. specimens sent to lab. CONCLUSION NORMAL VALUE 1. So nurses should have adequate knowledge regarding lumbar puncture. colorless None 0-0.R Brothers. Medical surgical Nursing-Assessment and management of clinical problems. .008/L 15-45mg/dl 15-25mg/dl 5-15mg/dl 45-75mg/dl None lumbar 60-150mm H2O with It is the most commom method of obtaining CSF for analysis. Clinical Nursing Procedure Manual. appearance of spinal fluid. Nurses often assist in this procedure because it is usually performed in the patient¶s room.Basic to advance skills. Page No: 77. COMPLICATION      CSF leakage Infection Interventricular disk damage Brain herination The client feels pressure in the lower back and may experience pain if a nerve root is touched with the needle during insertion. Lewis Collier Heitkemper. Document the procedure. NORMAL CSF VALUES PARAMETER Specific gravity pH Appearance RBCs WBCs Protein Lumbar Cisternal Ventricular Glucose Microorganisms Opening pressure puncture. N. Page No:277 3. and conditions and reaction of the patient. REFERENCES 1. Page No: 1677.35 Clear. Nursing Practicals and Procedures.007 7.I publications. 4th edition. Mosby¶s publication. Chennai. Keshav Swarnkar.

Sign up to vote on this title
UsefulNot useful