This document discusses lumbar puncture (spinal tap) procedures. It describes how a lumbar puncture is performed to withdraw cerebrospinal fluid (CSF) for diagnostic purposes such as testing for meningitis or tumors. The key steps of the procedure are outlined, including positioning and restraining the patient, cleaning the site, administering local anesthetic, inserting the needle into the subarachnoid space to collect CSF samples, and monitoring the patient afterwards. Potential complications are also listed.

1. APARNA A
1st year MSc Nursing
College Of Nursing
Kottayam

2. LUMBAR PUNCTURE or SPINAL TAP is carried
out by inserting a needle into Lumbar
subarachnoid space to withdraw C S F

3.  To obtain C S F for analysis & diagnosis of:
◦ Meningitis
◦ Meningoencephalitis
◦ Subarachnoid hemorrhage
◦ Malignancy – diagnosis and treatment
◦ Pseudotumor Cerebri
◦ Other neurologic syndromes
 To drain C S F & reduce intracranial space
 To instill medications

4.  Increased intracranial pressure
◦ Head CT before study if focal neurologic findings
present to rule out impending cerebral mass
herniation
• If platelet count is less than 40,000 and
Prothrombin time is less than 50% of control

5.  Hydrocephalus- Enlarged ventricle size & in
suspected normal pressure Hydrocephalus
 Coma- If C T is negative and I C P increased
 Meningitis- Exclude mass lesion & confirm
diagnosis

6.  Use smallest possible gauge [20/22]
 Prefer atraumatic rather than cutting needle
•1.5 in for < 1 yr
•2.5 in for 1 year to
middle childhood
•3.5 in for older
children and
adolescents
•Larger for large
adolescents

7.  Needle is inserted into subarachnoid space
through intervertebral space

8.  Spinal cord ends at L1-L2, so sites for puncture are
located at L3-L4 or L4-L5
 Restrain patient in lateral decubitus position
◦ Maximally flex spine without compromising
airway
◦ Keep alignment of feet, knees and hips
◦ Position head to left if right handed or vice versa

9. •Sterile CSF tray
with
•Spinal needle
•Anesthetic such as:
Topical- Zylocaine cream or
Lidocaine 1% with 25 gauge needle
and syringe
•Povidone-iodine solution & sponge
•Drapes, gauze, and bandages
•Manometer, stopcock, tubing and
specimen bottles

10.  Obtain a written consent for the procedure
 Explain the procedure to the patient
 Determine whether patient have any doubts
or misconceptions
 Reassure the patient
 Instruct patient to void after procedure

11. •Position the patient at one
side of edge of bed
•Place a small pillow under
patient’s head & another
between the legs
•Assist the patient to maintain
position
•Encourage patient to relax & to
breath normally
•Describe the procedure step by

12. •The physician cleanses the site
with antiseptic solution and drapes
the site
•Local anesthetic is injected to
numb the site and a spinal needle
is inserted to subarachnoid space
with stylet with bevel up to keep

13.  A specimen of C S F is collected usually in
three test tubes
 Needle is withdrawn & a small dressing is
applied at puncture site
 Sent specimen to lab
immediately

14.  Instruct patient to lie on prone for 2 to 3
hours
 Monitor patient for any complications
 Encourage increased fluid intake

15.  Headache
Back pain [Occasionally with short-lived ]
◦ Disc herniation if needle advanced too far
 Bleeding or fluid leak around spinal cord
 Infection, pain, hematoma
 Subarachnoid epidermal cyst
 Ocular muscle palsy (1%)
 Nerve Trauma
 Brainstem herniation

16.  Throbbing bifrontal & occipital headache
 Dull and deep in character
 Severe on sitting or standing
IT CAN BE AVOIDED BY:
Using small gauge needle
Keep patient prone after procedure for 2 hours,
then side-lying for 2-3 hours, then supine or
prone for 6 or more hours

17.  Bed rest
 Analgesics
 Hydration
 Epidural blood patch

18.  Clear and colourless
 Secreted by choroid plexus
 Exists in subarachnoid space
 It is about 150-200ml acts as shock absorber
transports nutrients

19. 1. If C S F is blood tinged 3 samples has to be
collected
2. Uniformly stained SA H
1 2 3
3. CSF clears in 3rd bottle-Traumatic trap
1 2 3

20.  Usually obtained for cell count, culture,
glucose and protein testing
 R B C and Differential W B C
 Bacteriological –Gram stain and culture
 Biochemical-Protein[0.15-0.45g/l]
- glucose [0.45-0.70g/l]

21.  SAH : Spectrophotometry
 Malignant Tumor: Cytology
 Tuberculosis: Polymerase chain reaction,
Jensen Culture
 Non-bacterial Infection: Virology, fungal &
parasitic studies
 Demyelinating Disease: Oligoclonal bands
 Neurosyphilis: V D R L test
 Cryptococcus: culture, antigen detection
 H I V : culture, antigen detection & antiviral
antibodies