- Time Out Procedure
- Place the patient in the appropriate position (upright or lateral decubitus)
- Palpate the Landmarks Tips of iliac crests should be approximately the L4-L5 interspace
- Can go in there or go up to the L3-L4
- Apply your mask and have door to room shut. Sterilely prep the area with betadine and drape it in the usual fashion
- Palpate the interspace again and position patient.
- Infiltrate the interspace with anesthetic Lidocaine without epinephrine
- Penetrate the L4-L5 or L3-L4 interspace with 22 gauge 3.5 inch spinal needle
- Direct needle towards the umbilicus
- You should feel a pop when you penetrate the ligament of flavin
- Let the spinal fluid drain. Approximately 1 mL per tube. 4 Tubes for adults and 3 peds.
- Withdraw needle and apply pressure and bandaid.
- Make pt lie prone for at least 60 minutes to help prevent spinal leak
- If send tubes in tube system send tubes 1 and 3 together and then 2 and 4.
Thursday, May 2, 2013
Lumbar Puncture Procedure
Lumbar Puncture Equipment
- Spinal Needle (usually 22 gauge or smaller 3.5 inches for adults)
- 1. 5 inch 22 gauge for pediatrics
- 1 inch 25 gauge for neonates
- LP kit
- Sterile Gloves and Mask
- Local Anesthetic and Syringes
Lumbar Puncture Contraindications
- Overlying infection of the LP site
- Elevated ICP or space occupying lesion
Lumbar Puncture Indications
- Diagnosis of Intracranial Infection
- Diagnosis of Subarachnoid Hemorrhage
- To screen for Pseudotumor cerebri
- Sometimes used in aide of diagnosis of multiple sclerosis and GBS.
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