LUMBAR PUNCTURE

INDICATIONS

• To Examine CSF in infection/ malignancy/ chemotherapy

CONTRAINDICATIONS

• Raised intracranial pressure( perform Fundoscopy prior)

• Platelet <50,000/mm3/ clotting defects

• Overlying skin infection/ comatose – unstable patient

EQUIPMENT

• Antiseptic skin cleaning agent

• Lumbar puncture Needles

• Sterile gloves

• Local anaesthesia

• Disposable manometer if needed to check opening pressure

• Specimen bottles

• Plaster dressing

PROCEDURE

• Explain the procedure to the child and parents

• Positions- there are many methods to do this

Lying

• One Pillow under the patients head

• One side with knees drawn up to the abdomen and clasped by their hands

Sitting

• Patient straddles a straight back chair so that his back is facing the doctor

• The patient can fold their hands on the back of the chair and rest head on them

METHOD

• Clean the skin with an antiseptic agent

• Identify the area to be injected and infiltrate the area with local anaesthesia if needed

• Introduce the spinal puncture needle in the midline directing towards umbilicus, between the 2nd and 3rd lumbar vertebrae and into the subarachnoid space   

• Once you enter the space, attach the manometer if needed

• Remove the needle and collect CSF into the bottles- approx 7 to 10 drops in each specimen bottle

• Withdraw the needle once the specimens are taken and apply pressure with a clean swab on the area

• Clean the area with antiseptic solution and apply a plaster once the wound has healed.

• Make the patient lie down supinely preferable the head end lower as the procedure can cause a headache.

• Record the procedure