LUMBAR

PUNCTURE

DEFINITION
Lumbar puncture is the insertion of a needle into the lumbar subarachnoid space to withdraw
cerebrospinal fluid.
PURPOSE
 To administer spinal anaesthesia before surgery.
 To administer medication into spinal canal in case of meningitis.
 To reduce intracranial pressure.
 To perform diagnostic studies, e.g Myelogram
 To detect subarachnoid block

CONTRA-INDICATION
 Suspected epidural infection.
 Severe psychiatric /neurotic problems.
 Chronic backache.
 Intracranial bleeding.

ARTICLES
A sterile tray containing (LP SET)
 LP needle with stillette.
 Sponge holding forceps.
 Small bowls.
 Cotton balls, gauze piece, cotton pads.
 Dressing articles.
A Clean tray containing:
 Mackintosh and towel
 Kidney tray and paper bag
 Spirit, iodine, tincture benzoin.
 Lignocaine 2 percent.
 Adhesive plaster
 Sterile normal saline.
 Sterile gauze piece
 Gloves, gown, mask
 3 way adapter, manometer, tubing.
 Syringe and needle for local anaesthesia.

PROCEDURE

NURSING ACTION RATIONALE

Instruct the patient not to make any movement Movement during the procedure causes injury of
during the procedure. spinal cord and its nerves.
Check BP, pulse and respiration. Helps in obtaining a base line data.
Position the patient on one side at the edge of the Flexion of the thighs and legs increase the space
bed with back towards the physician .thighs and between vertebrae and facilitates easy entry of
legs are flexed as much as possible(c-shape) needle into an arachnoid space.
position. The head and neck are flexed and brought
towards chest. Keep hands between knees.
Keep a pillow under the head and between the legs Pillow under the head maintains the spine in
of patient. horizontal position.
Pillow under legs prevents the upper leg from
 rolling forward.
Encourage the patient to relax and breath normally Hyperventilation may cause an error in pre
during procedure, remind patient that he should not reading
talk.
Fold back the upper garments above the waist line Avoids over exposure of the patient.
and the lower garments below the hip exposing the
site.
Assist the physician in cleaning the puncture site Prevent risk of infection.
with antiseptic solution and injecting local
anaesthetic.
Spinal needle is inserted into the subarachnoid
space by physician through the 3rd ,4th and 5th
lumbar intercostal.
Physician removes the satellite and disconnects Obtains CSF pressure. Normal pressure is 6-13
three way adaptor with manometer filled with mm of Hg or 80- 180 cm of water.
normal saline.
Collect CSF specimen into 3 specimen bottles after
measuring pressure.
Needle is withdrawn by physician.
Assist physician in sealing the puncture site with Dressing protect and prevents leakage of CSF
tincture benzoin and apply sterile dressing. from puncture site.

Instruct the patient to be flat for 12-24hours. Decrease CSF pressure in the caudal area where
the needle insertion occurred and decrease the
risk of leakage.
Monitor for complications of lumbar puncture, Post lumbar headache may appears a few hours
check vital signs every half an hour for 3-4 hours to several days after procedures.
till stable.
Check puncture site frequency for CSF leakage.

Encourage patient to take more fluids after the Reduce the risk of post lumbar headache by re-
procedure. establishing the CSF volume.
Record the procedure with date, time, CSF
pressure, amount drawn, colour, nature of CSF.

Send the specimen to lab. Detect chemical, bacteriological and cellular

If no complication are observed give upright

COMPLICATIONS
 CSF leakage
 Infection
 Post puncture headache
 Paralysis
 Hematoma.

SPECIAL CONSIDERATIONS
 Monitor for neurological changes such as change in the level of consciousness, pupil size,
numbness and tingling or pain in the legs or lower back ,during and after the procedure .
  If spinal headaches is present , instruct patient to
I. Increase fluid intake.
II. Avoid aspirin and caffeine.
III. Keep lights dim in the patients room
IV. Avoid excessive stimulation
V. Avoid valsalva maneuver.
VI. Administer pain medications.
VII. Maintain flat position for 12-24 hours without pillows.
 Once needle enter subarachnoid space ,help patient to slowly legs to reduce false recording of
increased ICP , increased muscle tension and compression may elevate pressure recording,
 If pressure reading is not required after introduction of the needle into subarachnoid space, the
CSF specimen is taken, in this case the three way adaptor and manometer tubing is not required.

CONCLUSION:
Lumbar puncture is a procedure that is often performed in the emergency department to obtain
information about the cerebrospinal fluid (CSF). Although usually used for diagnostic purposes to rule out
potential life-threatening conditions (eg, bacterial meningitis or subarachnoid hemorrhage), it is also
sometimes used for therapeutic purposes (eg, treatment of pseudotumor cerebri). CSF fluid analysis can
also aid in the diagnosis of various other conditions (eg, demyelinating diseases and carcinomatous
meningitis).
REFERENCES:
 Sandhya Ghai, Clinical Nursing Procedures, CBS Publisher amnd Distributor Pt. Ltd., 1st edition,
pg. no. 503-508
 Sister Nancy, Principles and Practice of Nursing, Vol 2, N. R. Publishing House, 5TH Edition, Pg.
no. 229-233