Lumbar puncture
Revised: July 08, 2022
Overview
Lumbar puncture (LP), or spinal tap, is an invasive procedure used to collect and test cerebrospinal fluid (CSF),
which surrounds the brain and spinal cord to protect them from injury. When teaching a patient about an LP,
describe what the test entails. For example, explain that it is performed in the lower back (lumbar region). A
needle is inserted between two vertebrae in the lower back to remove CSF.
Explain the purpose for the test as it pertains to the patient’s medical history. Tell the patient that a lumbar
puncture can assist with identifying disorders affecting the central nervous system (CNS), identifying CSF
infections (such as meningitis), as well as injecting medications (such as anesthetic, dye, and chemotherapy) into
the CSF for diagnosis and treatment. Prepare the patient for what to expect during the procedure, and reassure
the patient that although the test is generally recognized as safe, the most common risk (in 10% to 30% of
patients) is post-procedure headache caused by CSF leakage. Make the patient aware that resting in a supine
position will usually lessen or resolve the headache.
Why It’s Done
Discuss with the patient the reasons why a lumbar puncture is performed and detail the purpose that applies to
your patient:
CSF analysis: Explain to the patient that CSF is collected via LP for the diagnosis and treatment of
inflammatory conditions of the CNS (for example, Guillain-Barre syndrome or multiple sclerosis).
Diagnosis of CNS infections: Explain to the patient that an LP can be performed to determine the
presence of infection in the CSF, including bacterial, fungal, or viral infections (for example, meningitis,
encephalitis, or syphilis).
Medication administration: Tell the patient that LP may be used to inject medications such as
chemotherapy drugs to treat cancers involving the brain or spinal cord.
Contrast dye injection: Explain to the patient that an LP can be performed to inject dye or radioactive
substances, such as contrast for diagnostic imaging, computed tomography (CT) scan, or magnetic
resonance imaging to detect bleeding in the brain.
Preparing for the Procedure
Explain to the patient that the health care practitioner will ask questions about medical history and
medications. Explain that the health care practitioner will also do a physical examination, order a blood test
to check for bleeding/clotting disorders, and order diagnostic tests, such as a CT scan, to determine if there
is any swelling in or around the brain.
Instruct the patient to wear comfortable, loose-fitting clothes.
What to Expect during the Procedure
Explain to the patient that the procedure is usually done in an outpatient facility or a hospital. Explain that the
patient will need to change into a hospital gown so that the practitioner performing the procedure will have access
to the spine. (See Lumbar puncture.)
Tell the patient that the practitioner performing the test is typically a physician, physician’s assistant, or
nurse practitioner.
Explain that the patient will lie on one side on the examination table or bed with the chin tucked to the
chest and the knees to the abdomen, or the patient will sit on the edge of the examination table or hospital
bed with the head flexed to the chest. Both positions help arch the back and widen intervertebral spaces.
Explain to the patient that the skin site is cleansed with an antiseptic solution. Then, explain that a local
anesthetic may be injected to numb the site to make the LP less painful. Once the area is numb, a hollow
needle is inserted between spaces in the spinal column (subarachnoid space) where the CSF is located.
Explain that the patient may feel pressure once the needle is in place and the CSF pressure is measured.
Explain that a small amount of CSF may be removed or medication injected (whichever is applicable), the
needle removed, and the puncture site covered with a bandage.
Inform the patient that the procedure usually lasts about 15 minutes.
Lumbar puncture
Use this image to show the lumbar puncture technique
Complications
Warn the patient that minor and major complications can occur with LP even when sterile technique and
proper procedure are utilized.
Tell the patient that complications that may occur with LP include:
postlumbar headache due to CSF leakage (affects around 25% of patients)
back pain or discomfort due to needle insertion (affects around 25% of patients)
numbness or pain that radiates (affects around 15% of patients)
paralysis or paraparesis (affects around 1.5% of patients)
bleeding
infection
brain stem herniation (compression of the brain stem within the skull due to increased pressure from
some type of lesion; uncommon).
After the Procedure
Tell the patient to lie flat for about 1 hour after the LP to reduce the risk of postlumbar headache.
Inform the patient that it is necessary to drink fluids to rehydrate and replace the CSF withdrawn during the
procedure. This also reduces the chance of postlumbar headache.
Let the patient know that laboratory technicians will analyze the CSF and inform the health care practitioner
of the results.
Inform the patient that light activities should be engaged in for the rest of the day and for the next 24
hours.
The patient should notify the health care practitioner of any abnormalities, such as:
drainage of blood or fluid from the injection site
pain at the injection site
inability to urinate
headache that persists for more than a few hours after the procedure or with a change of position.
Tell the patient to resume normal activities and diet if no complications occur after 24 hours.
Related Patient Teaching Handouts
Aseptic Meningitis Discharge Instructions
Bacterial Meningitis
Creutzfeldt-Jakob Disease
Encephalitis
Epidural Blood Patch
Septic Arthritis
Hydrocephalus
Listeria
Lumbar Puncture (Spinal Tap)
Optic Neuritis
Subarachnoid Hemorrhage
Syphilis
Tickborne Encephalitis
Selected References
(Rating System for the Hierarchy of Evidence for Intervention/Treatment Questions)
1. Bentley, S. (2019). Bedside ultrasonography for lumbar puncture. Medscape.
http://emedicine.medscape.com/article/1458641-overview
2. Bodilsen, J., et al. (2020). Association of lumbar puncture with spinal hematoma in patients with and
without coagulopathy. Journal of the American Medical Association, 324(14), 1419–1428. Retrieved June
2022 from https://doi.org/10.1001/jama.2020.14895 (Level IV)
3. Campo, T. M., & Lafferty, K. A. (2022). Essential procedures for emergency, urgent, and primary care
settings: A clinical companion (3rd ed.). Springer.
4. Droby, A., et al. (2020). Low cerebrospinal fluid volume and the risk for post-lumbar puncture headaches.
Journal of the Neurological Sciences, 417, 117059. (Level IV)
5. Ertas, A., et al. (2021). Risk of intervertebral disc joint puncture during lumbar puncture. Clinical Neurology
and Neurosurgery, 200, 106107. (Level VI)
6. Fischbach, F. T., et al. (2022). A manual of laboratory and diagnostic tests (11th ed.). Wolters Kluwer.
7. Johnson, K. S., & Sexton, D. J. (2021). Lumbar puncture: Technique, indications, contraindications, and
complications in adults. In: UpToDate, Aminoff, M. J. (Ed.).
8. Margolis, M. S., et al. (2021). Lumbar puncture for diagnosis of idiopathic intracranial hypertension in typical
patients. Journal of Neuro-Ophthalmology, 41(3), 375–378. (Level VI)
9. Nath, S., et al. (2018). Atraumatic versus conventional lumbar puncture needles: A systematic review and
meta-analysis. Lancet, 391(10126), 1197–1204. (Level I)
10. Nobuhara, C. K., et al. (2021). Risk of spinal hematoma after lumbar puncture. Journal of the American
Medical Association, 325(8), 787–788. Retrieved June 2022 from https://doi.org/10.1001/jama.2020.24601
11. RadiologyInfo.org. (2022). Lumbar puncture. Retrieved June 2022 from
https://www.radiologyinfo.org/en/info/spinaltap
12. Shlamovitz, G. Z. (2020). Lumbar puncture. Medscape. http://emedicine.medscape.com/article/80773-
overview
Rating System for the Hierarchy of Evidence for Intervention/Treatment Questions
The following leveling system is from Evidence-Based Practice in Nursing and Healthcare: A Guide to Best
Practice (2nd ed.) by Bernadette Mazurek Melnyk and Ellen Fineout-Overholt.
Level I: Evidence from a systematic review or meta-analysis of all relevant randomized
controlled trials (RCTs)
Level II: Evidence obtained from well-designed RCTs
Level III: Evidence obtained from well-designed controlled trials without randomization
Level IV: Evidence from well-designed case-control and cohort studies
Level V: Evidence from systematic reviews of descriptive and qualitative studies
Level VI: Evidence from single descriptive or qualitative studies
Level VII: Evidence from the opinion of authorities and/or reports of expert committees
Modified from Guyatt, G. & Rennie, D. (2002). Users' Guides to the Medical Literature. Chicago, IL: American
Medical Association; Harris, R.P., Hefland, M., Woolf, S.H., Lohr, K.N., Mulrow, C.D., Teutsch, S.M., et al. (2001).
Current Methods of the U.S. Preventive Services Task Force: A Review of the Process. American Journal of
Preventive Medicine, 20, 21-35.
