Adult Health Nursing-
2
Topic : Lumber Puncture
Submitted by: Faiza Farooq
Submitted to: Ma’am Fozia
Lumber Puncture
Key points
Introduction
Procedure
Diagnostic Indications
Equipments
Personnel
Position
Clinical significance
Cerebrospinal fluid analysis
Post-Lumber Puncture Headaches
Other Complications of Lumber Puncture
Introduction
A lumber puncture (spinal tap) is carried out by inserting a needle
into the lumber subarachnoid space to withdraw CSF.
The test may be performed to obtain CSF from examination, to
measure and reduce CSF pressure, to determine the presence or
absence of blood in the CSF , and to administer medications
intrathecally ( into the spinal canal )
Procedure
The procedure is typically performed under local
anaesthesia using a sterile technique. A hypodermic needle
is used to access the subarachnoid space and collect fluid.
Fluid may be sent for biochemical, microbiological, and
cytological analysis. Using ultrasound to landmark may
increase success.
Diagnostic Indication
The chief diagnostic indications of lumbar puncture are
for collection of cerebrospinal fluid (CSF).
Serious bacterial, fungal and viral infections, including
meningitis, encephalitis and syphilis .
Autoimmune neurological conditions.
Bleeding around the brain, known as subarachnoid
haemorrhage.
Certain cancers involving the brain or spinal cord.
Analysis of CSF may exclude infectious, inflammatory and
neoplastic diseases affecting the central nervous system.
Alzheimer’s disease and other forms of dementia.
EQUIPMENT
Spinal needle with a stylet (20 gauge or 22 gauge needle)
Four CSF collection vials
sterile drape
manometer with three-way valve
local anaesthetic
syringes with needles
Sterile gloves
mask with face shield
surgical cap
Disinfecting
solution
PERSONNEL
The lumbar puncture is generally performed by one
person.
A second person, typically, a nurse (RN), may assist with
the procedure.
The person performing the lumbar puncture and the
assistant should both be in sterile gowns and observe
sterile precautions throughout the procedure.
POSITION
The positioning of the patient in either a lateral recumbent
position or sitting position may be used.
The lateral recumbent position is preferred as it will allow
an accurate measurement of opening pressure, and it also
reduces the risk of post-lumbar puncture headache
The patient should be instructed to assume the foetal
position, which involves the flexion of the spine.
It may be helpful to instruct the patient to flex their back
“like a cat." By doing so, the space between the spinous
processes increases, allowing for easier needle insertion.
To help keep the needle at
the midline during insertion,
the lumbar spine should be
perpendicular to the table in
the sitting position and parallel
to the table if in the recumbent
position.
Check list
01- Wash hands
02- Communication with patient:
Introduce yourself to patient
03- Before Course :
The purpose of carrying out puncture can be described.
Absence of contradiction can be checked.
Informed consent can be obtained.
04- Position:
Posture cam be explained to the patient.
An assistant can help with patient positioning.
05- Identification of puncture site :
A puncture point can be determined.
06- Preparation of puncture site
Broad disinfection focusing on a puncture point can be carried out.
Preparation for sterile management can be achieved.
Puncture equipment can be induced appropriately.
07- Puncture Techniques.
The following are made as appropriate. Puncture site
Puncture angle
Support of the puncture needle
Confirmation of CSF flow
Connection of three way cock and simple column manometer
Measurement of opening pressure
Collection of CSF
Observation of characteristics of collected CSF
Measurement of final pressure
Removal of needle
Management of puncture site
Direction for rest can be performed
Major complication and means of prevention can be stated.
08- Documentation
CLINICAL SIGNIFICANCE
Lumbar puncture is one of the most commonly performed
procedures in the emergency department.
It is used in the diagnosis of potentially life-threatening
diseases such as meningitis and subarachnoid
haemorrhage.
A thorough understanding of anatomy, potential
complications, and various techniques helps to ensure a
successful and safe lumbar puncture.
Maintaining open communication with the patient
throughout the procedure may decrease patient anxiety
and assist in first attempt success.
CEREBROSPINAL FLUID
ANALYSIS
The CSF should be clear and colourless.
Pink, blood-tinged or grossly bloody CSF may indicate a
subarachnoid hemorrhage.
Specimens are obtained for cell count , culture, glucose, protein and
other tests .
The specimens should be sent to the laboratory immediately because
changes will take place and alter the result if specimens are allowed
to stand .
POST LUMBER PUNCTURE
HEADACHE
A post lumbar puncture headache, ranging from mild to severe ,
may occur a few hours to several days after the procedure.
It is particularly severe on sitting or standing but lessens or
disappears when the patient lies down .
The headache is caused by CSF leakage at the puncture site.
Post lumbar puncture headache may be avoided if a small gauge
needle is used and if the patient remains prone after the
procedure.
OTHER COMPLICATIONS OF
LUMBAR PUNCTURE
Other Complications include
Temporary voiding problems
Slight elevation of temperature
Backache or spasm
Stiffness of neck
REFERENCES
Medical-Surgical and Adult Health Nursing by Brunner
and Suddarth’s Edition 2024-2025
https://www.mayoclinic.org/tests-procedures/lumbar-punct
ure/about/pac-20394631
https://www.ncbi.nlm.nih.gov/books/NBK557553/
