![]() ![]() Place bandage over needle insertion site.Note that in cases of doing a lumbar puncture for raised ICP it may be necessary to take a closing pressure as well as an opening pressure.There is no need to replace the stylet to do this.Once all samples are taken withdraw needle. ![]() If getting cytology up to 20ml is required (the more CSF, the higher the sensitivity).Make sure bottles are in the correctly numbered sequence.Once pressure read, collect samples by placing sterile containers under the 3-way tap and turning it to let the CSF directly out.A normal opening pressure is 12-20 cmCSF.Once the CSF has stopped advancing (leaving a swinging menincus) remember this CSF pressure. Turn the 3-way tap upwards to allow CSF fluid to fill the manometer.With flow of CSF, attach manometer & 3-way tap to the needle.If obstructed, or if needle meets resistance, withdraw the needle with stylet in place, recheck position & re-attempt the procedure.If no flow, replace stylet, rotate spinal needle a few millimetres & then recheck.Remove stylet and check for flow of spinal fluid.Advance slowly through spinous ligament resistance until you feel some give (sometimes described as a “pop”) with change in resistance as needle enters subarachnoid space.Advance needle slowly in direction of umbilicus with bevel facing upwards (towards the ceiling) if patient in lateral position.Make sure stylet in place before advancing needle.During this time do a final check of your equipment and make sure you have an assistant to help with bottles Wait a few minutes for lignocaine to work. ![]() Always check for entrance to blood vessel prior to injection of lignocaine & never inject into spinal canal.With a green (22G) needle advance into subcutaneous tissues.With an orange (25G) needle raise intradermal wheal.Mark entry point with blunt end of needle.Identify & sterilise needle insertion site.Create your sterile area and put on sterile gloves.CSF pressure cannot be reliably measured in this position Flex trunk by having patient lean forward & rest elbows on table or on knees.Useful in patients with pulmonary disorders or potential airway compromise.excessive flexion can compromise upper airway Ensure craniospinal & transverse planes remain stable.Ask or use assistant to draw patient’s legs up to their chest.Knees & torso flexed to optimise interlaminar foramen of vertebrae.Patient on his or her side with head propped up on a single pillow to keep spine straight.A lumbar puncture can be performed in two positions:.One glucose tube (fluoride oxalate tube, often grey).Four universal CSF sample containers (labelled 1-4).Familiarise yourself with this first and ensure it turns freely.Spinal needle (atraumatic needles reduce headache).Advice on hydration, caffeine intake and lying flat for one hour post-procedure (though no good evidence for this)Įquipment required for lumbar puncture (LP) Usually resolves within a couple of hours with simple analgesia.Headache (in up to one third of patients).Warn patient they may feel a shooting pain down one of their legs as the needle goes in and to tell you if they do so. Damage to surrounding structures (including nerves and vessels).Document informed consent (written if possible).If doing the LP for possible subarachnoid haemorrhage, ensure 12 hours have passed since the onset of symptoms.Check for allergies to latex, betadine, lignocaine or other medications.Ensure absence of infection or metalwork at lumbar puncture site.Check platelets and clotting reasonable.Any false localising signs noted (e.g.Assess risk of raised intracranial pressure.Spinal cord injury and bleeding into spinal canal (very rare).Possible complications of lumbar puncture (LP) Abscesses, tumours, intracranial haemorrhage, subdural haematomas Papilloedema or signs raised intracranial pressure.Presence of infection at lumbar puncture site. ![]()
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