“KRISHNA INSTITUTE OF MEDICAL SCIENCES

DEEMED UNIVERSITY, KARAD.”

“KRISHNA INSTITUTE OF NURSING SCIENCES,
KARAD”.
SUB.-ADVANCED NURSING PRACTICE
TOPIC- “LUMBAR PUNCTURE PROCEDURE ”

PRESENTED BY, GUIDED BY,

MISS.PRIYANKA JADHAV Mrs.NAMRATA MOHTE
1st MSc (NSG) STUDENT. MADAM
ASSISTAT PROFESSOR
KINS, KARAD.
 LUMBAR PUNCTURE

A lumbar puncture(LP) or spinal tap may be done to

diagnose or treat a condition. For this procedure, insert a hollow needle
into the space surrounding the spinal column (subarachnoid space) in
the lower back to withdraw some cerebrospinal fluid (CSF) or inject
medicine.

Definition- Lumbar puncture is the insertion of needle into the lumbar

subarachnoid space to withdraw cerebrospinal fluid.

Purposes :

1.To administer spinal anesthesia before surgery.

2.To administer medication into spinal canal in case of meningitis.

3.To reduce intracranial pressure.

4.To perform diagnostic studies ,e.g, Myelogram

5.To detect subarachnoid block.

  Diagnostic conditions:
A lumbar puncture procedure may be helpful in diagnosing
many diseases & disorders, including:

1.Meningitis- An inflammation of the membrane covering the brain &

spinal cord.

2.Encephalitis- An inflammation of the brain that is usually caused by a

virus.

3.Certain Cancers involving the brain & spinal cord

4.Bleeing-In the area between the brain & the tissues that cover it.

5.Reye syndrome -A sometimes fatal disease that causes severe

problems with the brain & other organs.

6.Myelitis – An inflammation of the spinal cord or bone marrow

7.Neurosyphilis- A stage of syphilis during which the bacteria invades

the central nervous system

8.Headache of unknown causes.

 Contraindication:

1.Suspected epidural infection

2.Severe psychiatric / neurotic problems

3.Chronic backache

4Intrachranial bleeding.

 Articles :

A sterile tray containing:

1. LP needle with stillete

2.Sponge holding forceps

3.Small bowls

4.Specimen bottles

5.cotton balls, gauze pieces ,cotton pads, etc.

 6.Dressing articles

A clean tray containing:

1.Mackintosh & towel

2.Kidney tray/ paper bag

3.Spirit,iodine,tincture benzoin

4.Sterile normal saline

5.Lignocaine 2%

6.Adhesive plaster & scissors

7.Sterile gloves, gown & mask

8.3-way adapter, manometer & tubing

9.Syringe & needle for local anesthesia. PROCEDURE:

NURSING ACTION RATIONALE

1.Identify the patient & explain the procedure to him. -Relieves anxiety & fear.
2.Instruct the patient to void before the procedure.
3.Instruct the patient not to make any movement
during the procedure.
4.Check BP ,pulse & respiration of patient.
5.Position the patient on one side at the edge of the
bed, with back towards the physician. Thighs & legs
are flexed as much as possible(c-shaped position).The
head & neck are flexed & brought towards chest.
Keep hands between knees.
6.Keep a pillow under the head.
7.Encourage the patient to relax & breath normally
during procedures. Remind patient that he/she
should not talk .
-Ensure that patient is comfortable.
-Movement during procedure causes injury to the
spinal cord & its nerves.
-Helps in obtaining a baseline date.
-Flexion of thighs & legs increases the space between
vertebrae & facilities easy entry of needle into
subarachnoid space.
-Pillow under the head maintains the spine in a
horizontal position.
-Hyperventilation may cause an error in pressure
reading.
 Nursing Action Rationale

8.Fold back the upper garments above the waist line -Avoids over exposure of the patient.
& the lower garments below the hip exposing the
site.

9.Assist the physician in cleaning the puncture site -Prevents risk of infection.
with antiseptic solution & injecting local anesthetics.

10.Spinal needle is inserted in subarachnoid space by

physician through the 3rd & 4th or 4th & 5th lumbar
intercostal space.
11.Physician remove the stiletto & connects three- -Obtain CSF pressure. Normal pressure is 6-13mm of
way adaptor with manometer filled with normal mercury or 80-180cm of water.
saline.
12.Collect CSF specimen into 3 specimen bottles after
measuring pressure.
13.Needle is withdrawn by physician.

14. Assisting physician in sealing the puncture site -Dressing protects & prevents leakage of CSF from
with tincture benzoin & apply sterile dressing. puncture site.

15.Instruct the patient to be flat for 12-4 hours.
16.Monitor for complications of lumbar puncture.
Check vital signs every half an hour for 3-4 hrs till
stable.
17.Check puncture site frequently for CSF leakage.
-Decreases CSF pressure in the caudal area where the
needle insertion occurred & decreases the risk of
leakage.
-Post lumbar headache may appear a few hours to
several days after procedure.

18.Encourage patient to take more fluid after the -Reduces the risk of post lumbar headache by
procedure. reestablishing the CSF volume.

19.Record the procedure with date, time, CSF

pressure ,amount drown ,color, nature of
cerebrospinal fluid & general condition of patient
during & after the procedure.
20.Send the specimen to the laboratory with proper -Detect chemicals, bacteriological & cellular
labels & requisition forms. composition of CSF & helps to diagnose the disease.

21.If no complications are observed, give upright

position to the patient after 4 hours.
 Special consideration:
1.Monitor for neurological changes such as change in the level of
consciousness, pupil size, numbness & tingling or pain in the legs or lower
back ,during & after the procedure.
2.If spinal headache is present, instruct patient to
-Increase fluid intake
-Avoid aspirin & caffeine
-Keep lights dim in the patient’s room
-Avoid excessive stimulation
-Avoid Valsalva maneuver
-Administer pain medications
-Maintain flat position for 1-24 hours without pillows.
3.Once needle enters subarachnoid space, help patient to slowly straighten
legs to reduce false recording.
4.If pressure reading is not required after introduction of the needle into
space, CSF specimen is taken .in this case, the three-way adapter &
manometer tubing are not required.

 COMPLICATIONS:
1.CSF leakage
2.Infection
3.Postpuncture headache
4.Paralysis
5.Hematoma