© 2023 Lippincott Advisor - Diagnostic Tests: Lumbar punc https://advisor.lww.com/lna/pages/printPag
Lumbar puncture
Revised: July 08, 2022
Overview
Description
• Insertion of a sterile needle into the subarachnoid space in the spinal canal, usually between the third
and fourth (or fourth and fifth) lumbar vertebrae
• Permits sampling of cerebral spinal fluid (CSF) for qualitative analysis
• Also known as a spinal tap
Purpose
• To measure CSF pressure and obtain a sample for CSF analysis
• To help diagnose viral or bacterial meningitis, subarachnoid or intracranial hemorrhage, demyelinating
diseases (such asGuillain-Barré syndrome and multiple sclerosis), tumors and brain abscesses,
neurosyphilis, and chronic central nervous system infections
• To detect blood in CSF
• To drain CSF
• To inject anesthetic agents, dyes, radioactive substances, or medications into the CSF
Preparation
• Ensure that informed consenthas been obtained and that the signed consent form is in the patient's
medical record.
• Note that no dietary restrictions are required for this test.
• Ask the patient about any medications or supplements that may affect bleeding tendencies, and report to
the practitioner as needed.
• Note and report all allergies.
Teaching Points
Be sure to include the patient's family or caregiver in your teaching, when appropriate.
• Explain the purpose of the test and describe how it's done.
• Tell the patient who will perform the test and where it will take place.
• Inform the patient that fasting isn't required before the test.
• Inform the patient that headache is the most common adverse effect.
• Tell the patient that the test takes at least 15 minutes.
Diagnostic Procedure
Key Steps
• Perform hand hygiene and follow standard precautions
• Confirm the patient's identity using at least two specific and unique patient identifiers.
• Place the patient in a side-lying position at the edge of the bed with the knees drawn up to the abdomen
and the chin tucked against the chest (the fetal position). Alternatively, place the patient in a sitting
position while leaning over with the head flexed to the chest.
• If the patient is in a supine position, provide pillows to support the spine on a horizontal plane.
• The practitioner performs the procedure using sterile technique.
• A team member cleans the skin site with an antiseptic solution and drapes the surrounding area.
1 of 5 4/10/23, 10:23 AM
, © 2023 Lippincott Advisor - Diagnostic Tests: Lumbar punc https://advisor.lww.com/lna/pages/printPag
• The practitioner injects a local anesthetic.
• The practitioner inserts the spinal needle in the midline between the spinous processes of the vertebrae
(usually between the third and fourth or fourth and fifth lumbar vertebrae).
• The practitioner removes the stylet from the needle; CSF will drip out of the needle if it's properly
positioned.
• The practitioner attaches a stopcock and manometer to the needle to measure the patient's initial
(opening) CSF pressure.
WARNING!
If the opening CSF pressure is greater than 200 mm Hg in a relaxed patient, the
practitioner should remove no more than 2 mL of CSF.
• The practitioner collects the specimens in appropriate containers
• Label the specimens as appropriate and send them to the laboratory immediately.
WARNING!
Never place CSF samples in a refrigerator because refrigeration alters the results
of bacteriologic and fungal studies.
• The practitioner removes the needle and applies a small sterile dressing.
WARNING!
Throughout the procedure, closely observe the patient for signs of an adverse
reaction (such as an elevated pulse rate, pallor , and clammy skin).
Postprocedure Care
• Monitor the patient for post-lumbar puncture headache, which usually begins in 24 to 48 hours.
• If the patient experiences a headache, position the patient supine.
• Encourage the patient to drink fluids (to prevent headache), and assist as needed.
• Provide analgesics, as needed
• Monitor the patient's vital signs, neurologic status, and intake and output.
• Monitor the puncture site for redness, swelling, and drainage.
• Inform the practitioner of abnormal results.
Precautions
WARNING!
Lumbar puncture is contraindicated in a patient with skin infection at the
puncture site, a severe psychiatric or neurotic problem, chronic back pain , or
previous spinal surgery or scarring at the puncture site.
2 of 5 4/10/23, 10:23 AM
Lumbar puncture
Revised: July 08, 2022
Overview
Description
• Insertion of a sterile needle into the subarachnoid space in the spinal canal, usually between the third
and fourth (or fourth and fifth) lumbar vertebrae
• Permits sampling of cerebral spinal fluid (CSF) for qualitative analysis
• Also known as a spinal tap
Purpose
• To measure CSF pressure and obtain a sample for CSF analysis
• To help diagnose viral or bacterial meningitis, subarachnoid or intracranial hemorrhage, demyelinating
diseases (such asGuillain-Barré syndrome and multiple sclerosis), tumors and brain abscesses,
neurosyphilis, and chronic central nervous system infections
• To detect blood in CSF
• To drain CSF
• To inject anesthetic agents, dyes, radioactive substances, or medications into the CSF
Preparation
• Ensure that informed consenthas been obtained and that the signed consent form is in the patient's
medical record.
• Note that no dietary restrictions are required for this test.
• Ask the patient about any medications or supplements that may affect bleeding tendencies, and report to
the practitioner as needed.
• Note and report all allergies.
Teaching Points
Be sure to include the patient's family or caregiver in your teaching, when appropriate.
• Explain the purpose of the test and describe how it's done.
• Tell the patient who will perform the test and where it will take place.
• Inform the patient that fasting isn't required before the test.
• Inform the patient that headache is the most common adverse effect.
• Tell the patient that the test takes at least 15 minutes.
Diagnostic Procedure
Key Steps
• Perform hand hygiene and follow standard precautions
• Confirm the patient's identity using at least two specific and unique patient identifiers.
• Place the patient in a side-lying position at the edge of the bed with the knees drawn up to the abdomen
and the chin tucked against the chest (the fetal position). Alternatively, place the patient in a sitting
position while leaning over with the head flexed to the chest.
• If the patient is in a supine position, provide pillows to support the spine on a horizontal plane.
• The practitioner performs the procedure using sterile technique.
• A team member cleans the skin site with an antiseptic solution and drapes the surrounding area.
1 of 5 4/10/23, 10:23 AM
, © 2023 Lippincott Advisor - Diagnostic Tests: Lumbar punc https://advisor.lww.com/lna/pages/printPag
• The practitioner injects a local anesthetic.
• The practitioner inserts the spinal needle in the midline between the spinous processes of the vertebrae
(usually between the third and fourth or fourth and fifth lumbar vertebrae).
• The practitioner removes the stylet from the needle; CSF will drip out of the needle if it's properly
positioned.
• The practitioner attaches a stopcock and manometer to the needle to measure the patient's initial
(opening) CSF pressure.
WARNING!
If the opening CSF pressure is greater than 200 mm Hg in a relaxed patient, the
practitioner should remove no more than 2 mL of CSF.
• The practitioner collects the specimens in appropriate containers
• Label the specimens as appropriate and send them to the laboratory immediately.
WARNING!
Never place CSF samples in a refrigerator because refrigeration alters the results
of bacteriologic and fungal studies.
• The practitioner removes the needle and applies a small sterile dressing.
WARNING!
Throughout the procedure, closely observe the patient for signs of an adverse
reaction (such as an elevated pulse rate, pallor , and clammy skin).
Postprocedure Care
• Monitor the patient for post-lumbar puncture headache, which usually begins in 24 to 48 hours.
• If the patient experiences a headache, position the patient supine.
• Encourage the patient to drink fluids (to prevent headache), and assist as needed.
• Provide analgesics, as needed
• Monitor the patient's vital signs, neurologic status, and intake and output.
• Monitor the puncture site for redness, swelling, and drainage.
• Inform the practitioner of abnormal results.
Precautions
WARNING!
Lumbar puncture is contraindicated in a patient with skin infection at the
puncture site, a severe psychiatric or neurotic problem, chronic back pain , or
previous spinal surgery or scarring at the puncture site.
2 of 5 4/10/23, 10:23 AM
