LUMBAR

PUNCTURE
 DEFINITION
• Puncture of the subarachnoid space in the
lumbar region of the spinal cord to withdraw
cerebrospinal fluid or inject drugs.
 PURPOSES
• collect a sample of cerebrospinal fluid
• measure the pressure of fluid in the spinal canal
• inject drugs
• To detect
• bacterial, fungal and viral infections, including meningitis,
encephalitis and syphilis
• bleeding around the brain (subarachnoid hemorrhage)
• cancers involving the brain and spinal cord
• inflammatory conditions of the nervous system, including
Guillain-Barre syndrome and multiple sclerosis.
 INDICATIONS
• Diagnosis of diseases with altered CSF composition
• Intrathecal administration of pharmaceuticals
• CSF pressure measurement
NEEDLE TYPES
NEEDLE FOR LP
GAUGE (mm) COLOR CODE

16G (1.6 mm) White

SPINAL NEEDLE SIZES

18G (1.2 mm) Pink

19G (1.1 mm) Cream
20G (0.9 mm) Yellow
21G (0.8mm) Deep green
22G (0.7 mm) Black
24G (0.6 mm) Deep blue
25G (0.5 mm) Orange
26G (0.45mm) Brown
27G (0.4mm) Gray
Parameter Normal value

Total volume 150 ml

CSF pressure 6- 14 mmof HG
Specific gravity 1.006 – 1.008
Glucose 40 – 70 mg/dl
Proteins 20 – 40 mg/dl
Lactate 1 – 2mmol/L
Red blood cells None
White blood cells 0 – 5 cells/ microliter
Appearance Clear colourless
 ARTICLES
• STERILE DRESSING
• STERILE GLOVES
• STERILE DRAPE
• ANTISEPTIC SOLUTION WITH SKIN
SWABS
• LIDOCAINE 1% WITHOUT
EPINEPHRINE
• SYRINGE, 3 ML
• NEEDLES, 20 AND 25 GAUGE
• SPINAL NEEDLES, 20 AND 22
GAUGE
• THREE-WAY STOPCOCK
• MANOMETER
 COMPLICATIONS
• Post–spinal puncture headache
Headache is the most common
complication of lumbar puncture,
observed in 20-70% of patients. It
usually begins 24-48 hours after the
procedure and is more common in
young adults.
2) BLOODY TAP
3) DRY TAP
 4)INFECTION

•Cellulitis, skin abscesses, epidural

abscesses, spinal abscesses, and discitis
can result from a contaminated spinal
needle
5)HEMORRHAGE
 DYSESTHESIA
IRRITATION OF NERVES OR NERVE ROOTS BY THE SPINAL
NEEDLE CAN CAUSE DIFFERENT LOWER-EXTREMITY
DYSESTHESIAS.
 6) POST–DURAL PUNCTURE CEREBRAL
HERNIATION

• withdrawal of fluid when initial pressures are abnormal could

result in spinal cord compression or cerebral herniation