Marienela Gay M.

Wagas BSN III C

Ateneo de Zamboanga University
College of Nursing NURSING SKILLS OUTPUT (NSO) Report No. 5 LUMBAR PUNCTURE
DESCRIPTION:

A lumbar puncture is a diagnostic and at times therapeutic procedure that is performed in order to collect a sample of cerebrospinal fluid (CSF) for biochemical, microbiological, and cytological analysis, or very rarely as a treatment ("therapeutic lumbar puncture") to relieve increased intracranial pressure.
MATERIALS / EQUIPMENT NEEDED:

• • • • • •

Sterile gloves Sterile lumbar puncture set Skin antiseptic Band Aid Xylocaine 1% - 2% Cotton balls

PROCEDURE:

1. 2. 3. 4.

Check the patient’s name. Explain procedure to the client. Check physician’s directives. Wash hands prior the procedure.

For Lying position: 5. Position the patient on side with a small pillow under head and a pillow between legs. Patient should be lying on a firm surface. 6. Instruct patient to arch the lumbar segment of back and draw knees up to abdomen, chin to chest, clasping knees and hands. For sitting position: 7. Have the patient straddle straight-back chair (facing the back) and rest head against arms, which are folded on the back of the chair. 8. The skin is prepared with antiseptic solution, and the skin and subcutaneous apces are infiltrated with local anesthesia agent. 9. A spinal puncture needle is introduced at the L3-L4 interspace. The needle is advanced until the “give” of the ligamentum flavum is felt and the needle enters the subarachnoid space. The monometer is attached to the spinal puncture needle. 10. After the needle enters the subarachnoid space, help the patient to slowly straighten legs. 11. Instruct the patient to breathe quietly (not to hold breath or strain ) and not to talk. 12. The initial pressure reading is obtained by measuring the level of the fluid column after it comes to rest. 13. About 2-3 ml of spinal fluid is placed in each of three test tubes for observation, comparison, and laboratory analysis. 14. After the procedure, the patient is asked to remain prone (on abdomen) for about 3 hours. 15. Wash hands after the procedure. January 12, 2010 _____________________ Date Mr. Joel Gallego, RN ________________________ Clinical Instructor’s Initials

Marienela Gay M. Wagas BSN III C Diagram / Illustration

NURSING RESPONSIBILITIES Before Procedure 1. Check the patient’s name 2. Check physician’s directives. 3. Wash hands before administering ear drops 4. Check the materials. 5. Ask patient for any discomfort in his/her position. 6. Assist patient on any position. 7. Before procedure, the patient should empty his/her bladder and bowel. During Procedure 1. After the needle enters the subarachnoid space, help the patient to slowly straighten legs. 2. Instruct patient to breathe quietly and not to talk. After Procedure 1. After the procedure, the patient is asked to remain prone (on abdomen) for about 3 hours. 2. Discard soiled tissues and cotton in a bag that can be closed and discarded. 3. Wash hands after procedure. January 12, 2010 _____________________ Date Mr. Joel Gallego, RN ________________________ Clinical Instructor’s Initials

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