It is a procedure that involves the insertion of a needle into the spinal canal ,to remove a sample of cerebrospinal fluid for tests and diagnosis .....in this study all the aspects of lumbar puncture is detailed in this study ... please comment thank you

1. Lumbar
Puncture
|a detailed study
PREPARED BY
MARTIN SHAJI
PHARM D

2. • Diagnostic:— Infectious
Meningitis
Encephalitis— Inflammatory
• Multiple Sclerosis
Guillain-Barre syndrome
— Oncologic
— Metabolic
— Spontaneous
Subarachnoid haemorrhage
Therapeutic:
— Analgesia
— Anaesthesia
— Antibiotics
— Antineoplastic
Indications

3. Spinal needle
— Less than 1 yr: 1.Sin
— l yr to middle childhood:2.51n
— Older children and adults: 3.51n
• Three-way stopcock
• Manometer
• 4 specimen tubes
• Local anaesthesia
. Drapes
. Betadine
Equipment's required

4. — Generally performed in the lateral
decubitus position.
— A pillow is placed under the head to
keep it in the same plane as the spine.
— Shoulders and hips are positioned.
perpendicular with the table.
— Lower back should breached toward
practitioner.
Position of the patient

5. • Performed with the patient in the
lateral recumbent position.
• A line connecting the posterior
superior iliac crest will intersect the
midline at approx. the 14spinous
process.
• Spinal needles entering the
subarachnoid space at this point are
well below the termination of the
spinal cord.

6. 1) Place infant on blue underpad (ensure underpad is removed
after skin preparation if any pooling of skin preparation solution
has occurred).
2) Position baby. Identify landmarks. Ensure the baby is as
straight as possible (particularly avoid rotation), but do not apply
flexion to the trunk until the needle is about to be inserted.
3) Apply face mask.
Procedure for lumbar puncture:

7. 4) Wash hands, gown and glove.
5) Cut 3 cm diameter hole in middle of plastic drape. (Plastic
drape helps visualization of infant during procedure.)
6) Prepare the skin. Wait for prep to dry
7) Identify L4. It helps to keep two fingers of your left hand
locating it - one each side.
8) Enter skin strictly in midline, aiming slightly towards the
head at between 70 and 90 degrees.

8. 9) Once through the skin, STOP. Wait for the infant to resettle.
10) Reorient yourself, making sure that you are still in the
midline and advancing at the appropriate angle. The subsequent
advance of the needle is less distressing than the initial insertion.
11) Advance needle about 0.5 cm. Remove stylette and
observe for CSF flow. If negative, fully reinsert the stylette
and advance a little further.
Repeat this process until CSF is obtained.

9. 12) A ‘pop’ or ‘give’ may be felt as the needle passes through the
posterior ligaments and dura, but do not rely on this. The
‘stop-start’ approach is less likely to give a bloody tap.
13) Allow CSF to drip into at least two tubes. A minimum of 10
drops/tube is required for microbiological and biochemical
examination.
14) Measure CSF pressure using a manometer if you are doing
a therapeutic tap. For a therapeutic tap, the maximum volume
to be tapped is 2 per cent of body weight.

10. 15) When adequate CSF has been obtained, replace the stylet
and then remove the needle. Apply pressure to the puncture
site with a sterile cotton wool ball or gauze to control ooze.
When ooze has ceased, use a band-aid or flexible collodion as
dressing.
16) Wipe excessive antiseptic prep from the skin with sterile
water.
17) Discard stylette and needle into sharps container.

11. LP in older children maybe performed
from L2 toL3 interspace to the L5 to
S1 interspace.
• At birth, the cord ends at the level of
L3.
• LP in infant may be performed at
the L4 to L5 or L5 to S1 interspace.

12. • CSF volume of 1cc obtained in 3 tubes.
• In the neonate, 2m1 in total can be safely removed.
• In an older child 3 to 6 ml can be sampled depending on the
child’s size.
• Tube 1 is used for determining protein and glucose
• Tube 2 is used for microbiologic and cytologic studies‘
Tube 3 is for cell counts and serologic tests for syphilis
Quantity required / drawm

13. • Herniation
• Cardiorespiratory compromise
• Pain
• Headache (36.5%)
• Bleeding
• Infection
• Subarachnoid epidermal cyst
• CSF leakage
Complications