ASSISTING IN LUMBAR
PUNCTURE
DEFINITION:
LUMBAR PUNCTURE - involves inserting a sterile needle into the subarachnoid
space of a patient's spinal canal, usually between the third and fourth (or fourth
and fifth) lumbar vertebrae.
PURPOSES OF LUMBAR PUNCTURE
- helps detect blood in cerebrospinal fluid (CSF)
- obtain CSF specimens for laboratory analysis
- to inject contrast media for radiologic studies
- administration drugs or anesthetics.
- to measure the pressure of CSF, which flows freely between the brain and
spinal column.
-
MATERIALS:
A lined hypotray containing:
- Antiseptic solution Caps
- Gloves
- Gown
- Labels (sterile and nonsterile)
- Laboratory biohazard transport bag
- Light source
- Local anesthetic (usually 1% lidocaine without Epinephrine)
- Manometer
- Masks with face shields or masks and goggles
- Overbed or procedure table
- Sterile 3-mL syringe
- Sterile 22G 31⁄2′′ spinal needle with stylet 1
- Sterile 25G 3⁄4′′ needle
- Sterile fenestrated drape
- Sterile gauze pads or sterile sponge sticks
- Sterile gloves
- Sterile gown
- Sterile marker
- Sterile occlusive dressing
- Sterile specimen collection tubes with caps
- Three-way stopcock
- Vital signs monitoring equipment
PROCEDURE RATIONALE
1. Verify the doctor’s orders.
2. Check the patient’s medical history for
any allergies, especially to latex, antiseptic
cleaning solution, or the local anesthetic.
3. If required by your facility, confirm that
informed consent has been obtained and
that the signed consent form is in the
patient's medical record.
4. Gather and prepare the necessary
equipment and supplies at the patient's
bedside or in the treatment area.
5. Conduct a pre-procedure verification to
make sure that all relevant documentation,
related information, and equipment are
available and correctly identified with the
patient's identifiers. If required, complete a
pre-procedure verification checklist, or
confirm that one is complete.
6. Perform hand hygiene.
7. Confirm the patient's identity using at
least two patient identifiers.
8. Provide privacy.
9. Reinforce the practitioner's explanation of
the procedure and answer the patient's
questions.
10. Inform the patient that a headache may
occur after lumbar puncture but provide
reassurance that cooperation during the
procedure minimizes this effect.
11. Instruct the patient to void.
12. Obtain the patient's vital signs and
assess the neurologic status.
13. Administer an analgesic or a sedative, if
ordered, following safe medication
administration practices.
14. Perform hand hygiene.
15. Provide adequate lighting at the
puncture site.
16. Raise the bed to waist level before
providing care.
17. Perform hand hygiene.
18. Put on gloves and other personal
protective equipment, as needed.
19. Position the patient in the side-lying or
sitting position according to the
practitioner's preference.
20. Reemphasize the importance of the
patient remaining as still as possible.
21. Remove and discard your gloves and
other personal protective equipment, if
worn.
22. Perform hand hygiene.
23. Put on a cap, a mask with a face shield
or a mask and goggles, a gown, and gloves.
24. Open the equipment tray on an overbed
or procedure table, being careful not to
contaminate the sterile field when you open
the wrapper.
25. Label all medications, medication
containers, and other solutions on and off
the sterile field using a sterile marker.
26. Place the patient’s towel under the
lumbar area.
27. Perform skin preparation using Betadine
cleanser three times and then Betadine
paint three times, in a circular fashion, from
inner to outer surface.
28. Don sterile gloves. Then hand the other
pair of sterile gloves to the physician.
29. Arrange the materials inside the stock
tray according to their use: eye-sheet, 3-cc
syringe for anesthesia, spinal needle, 3
specimen bottles and gauze.
30. Loosen the lids of the specimen bottle.
31. Give the following to the physician: With
the dominant hand:
-sterile eye sheet
-sterile syringe for anesthesia
With non-dominant hand:
-give the anesthesia solution. This hand is
now unsterile. Place it on your back after
serving the anesthesia.
32. If needed, disinfect the stopper of a
multidose vial of anesthetic with a
disinfectant pad, allow it to dry completely,
and invert the vial 45 degrees.
33. Tell the patient that the injection of local
anesthetic will cause a transient burning
sensation and local pain. Instruct the patient
to report persistent pain or other sensations.
34. Using your still sterile dominant hand,
give the spinal needle (trocar) to the
physician.
35. If needed, disinfect the stopper of a
multidose vial of anesthetic with a
disinfectant pad, allow it to dry completely,
and invert the vial 45 degrees.
36. During the procedure, instruct the
patient to remain still and breathe normally.
37. Monitor the patient closely for adverse
reactions. Alert the practitioner immediately
of any significant changes.
38. If ordered, help the patient extend the
legs.
Once the physician can insert the needle
into the sub-arachnoid space, he will
remove the stylet from the spinal needle
(trocar) to withdraw CSF. Hand the
specimen bottles individually. Assist the
physician in filling the three bottles.
39. Give the sterile gauze to the physician.
40. When the practitioner has finished
collecting the cerebrospinal fluid (CSF)
specimens, mark the tubes in sequence and
cap them tightly. Label the specimens in the
presence of the patient.
41. While the physician removes the needle
and applies pressure to the site. Remove the
eye sheet and secure the gauze with
plaster, starting from the center to the
sides, horizontally.
42. Assist the patient into a supine or prone
position.
43. Return the bed to the lowest position.
44. Discard used supplies in appropriate
receptacles.
45. Remove and discard your gloves and
other personal protective equipment.
46. Perform hand hygiene.
47. Place the CSF specimens in a laboratory
biohazard transport bag and send them
immediately to the laboratory with the
appropriate laboratory request forms (if
necessary).
48. Perform hand hygiene.
49. Document the procedure.
