Lumbar Puncture Procedure

• 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.