LUMBAR PUNCTURE
LUMBAR PUNCTURE
INDICATIONS
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To Examine CSF in infection/ malignancy/ chemotherapy
CONTRAINDICATIONS
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Raised intracranial pressure( perform Fundoscopy prior)
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Platelet <50,000/mm3/ clotting defects
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Overlying skin infection/ comatose – unstable patient
EQUIPMENT
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Antiseptic skin cleaning agent
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Lumbar puncture Needles
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Sterile gloves
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Local anaesthesia
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Disposable manometer if needed to check opening pressure
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Specimen bottles
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Plaster dressing
PROCEDURE
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Explain the procedure to the child and parents
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Positions- there are many methods to do this
Lying
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One Pillow under the patients head
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One side with knees drawn up to the abdomen and clasped by their hands
Sitting
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Patient straddles a straight back chair so that his back is facing the doctor
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The patient can fold their hands on the back of the chair and rest head on them
METHOD
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Clean the skin with an antiseptic agent
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Identify the area to be injected and infiltrate the area with local anaesthesia if needed
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Introduce the spinal puncture needle in the midline directing towards umbilicus, between the 2nd and 3rd lumbar vertebrae and into the subarachnoid space
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Once you enter the space, attach the manometer if needed
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Remove the needle and collect CSF into the bottles- approx 7 to 10 drops in each specimen bottle
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Withdraw the needle once the specimens are taken and apply pressure with a clean swab on the area
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Clean the area with antiseptic solution and apply a plaster once the wound has healed.
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Make the patient lie down supinely preferable the head end lower as the procedure can cause a headache.
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Record the procedure