Lumbar puncture (other name are spinal tap;spinal puncture;thecal puncture and rachiocentesis) is a procedure that is often performed in the emergency department by inserting needle into fluid within the spinal canal to obtain information about the cerebrospinal fluid (CSF). Although usually used for diagnostic purposes to rule out potential life-threatening conditions for example bacterial meningitis or subarachnoid hemorrhage, it is also sometimes used for therapeutic purposes for example treatment of pseudo tumor cerebri.

1. Lumbar puncture (other name are spinal tap;spinal puncture;thecal puncture and
rachiocentesis) is a procedure that is often performed in the emergency department by
inserting needle into fluid within the spinal canal to obtain information about the
cerebrospinal fluid (CSF).
Although usually used for diagnostic purposes to rule out potential life-threatening
conditions for example bacterial meningitis or subarachnoid hemorrhage,
it is also sometimes used for therapeutic purposes for example treatment of pseudo tumor
cerebri.
It can also be used to inject anesthetic medications or chemotherapy drugs into CSF.
CSF fluid analysis can also aid in the diagnosis of various other conditions such as
demyelinating diseases and carcinomatous meningitis .and other disorder of CNS such as
Guillain-barre syndrome and multiple sclerosis;or cancer of brain or spinal cord.
 Lumbar puncture should be performed only after a neurologic examination but should
never delay potentially life-saving interventions, such as the administration of
antibiotics and steroids to patients with suspected bacterial meningitis.
Indication of lumbar puncture
 to obtain celebro spinal fluid for analysis
 to check for spinal blockage attributable to a spinal cord lesion
 to inject contrast medium or air for diagnosis study
 to inject anesthetic that is “spinal anesthesia”
LUMBAR PUNCTURE

2.  to inject certain chemotherapy drugs (such as Baclofen)
 to reduce mild to moderate increased intracranial pressure in certain condition
 Measure the pressure of cerebrospinal fluid
 Inject dye (myelography) or radioactive substances (cisternography) into cerebrospinal
fluid to make diagnostic images of the fluid's flow
Information gathered from a lumbar puncture can help diagnose:
 Serious bacterial, fungal and viral infections, including meningitis, encephalitis and
syphilis
 Bleeding around the brain (subarachnoid hemorrhage)
 Certain cancers involving the brain or spinal cord
 Certain inflammatory conditions of the nervous system, such as multiple sclerosis and
Guillain-Barre syndrome
Its benefits
Depend on the exact situation for which it is performed but it can provide lifesaving
information.
When the CSF is examined in the laboratory, the following are evaluated:
 The number and types of white blood cells
 The level of glucose
 The types and levels of proteins
 The presence of bacteria, fungi or abnormal cells
Patient preparation
Before your lumbar puncture, your Doctor asks questions about your medical history, does a
physical exam, and orders blood tests to check if you have any bleeding or clotting disorders.
Your doctor may also recommend a CT scan to determine if you have any abnormal swelling
in or around your brain.

3. Tell your doctor if you're taking blood-thinning or other anticoagulant medications. Examples
include warfarin (Coumadin, Jantoven), clopidogrel (Plavix), and some over-the-counter pain
relievers such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).
Also, tell your doctor if you'ràe allergic to any medications, such as numbing medications
(local anesthetics).
What you can expect
Lumbar puncture is usually done in an outpatient facility or a hospital. You're asked to change
into a hospital gown.and the nurse asks the patient to empty his bladder as comfort,measure.
then position him on a comfortable side with the back close to the examination table.when the
physician is ready ,the nurse ask the client to bring the knees up as closer as possible to the
trunk and assume a fetal position.the nurse helps the client to achieve and maintain the
position. A pillow under the head and between the knees aids body alignment.
THE PROCEDURE
a.The skin site is thoroughly cleaned and A local anesthetic is injected into your lower back to
numb the puncture site before the needle is inserted. The local anesthetic will sting briefly as
it's injected
b.A thin, hollow needle is inserted between the two lower vertebrae (lumbar region), through
the spinal membrane (dura) and into the spinal canal. You may feel pressure in your back
during this part of the procedure.
c.Once the needle is in place, you may be asked to change your position slightly.
Fig1.a Cleanandinjectectanastheticdrugonthe site
Fig1.b:needle isinserted

4. d.The cerebrospinal fluid pressure is measured, a small amount of fluid is withdrawn, and the
pressure is measured again. If needed, a drug or substance is injected.
e.The needle is removed, and the puncture site is covered with a bandage.
The procedure usually lasts about 45 minutes. Your doctor may suggest lying down after the
procedure
Results
The spinal fluid samples are sent to a laboratory for analysis. Lab technicians check for a
number of things when examining spinal fluid, including:
 General appearance. Spinal fluid is normally clear and colorless. If it's cloudy, yellow
or pink in color, it may indicate infection.
 Protein (total protein and the presence of certain proteins). Elevated levels of total
protein — greater than 45 milligrams per deciliter (mg/dL) — may indicate infection or
another inflammatory condition. Specific lab values may vary from medical facility to
medical facility.
 White blood cells. Spinal fluid normally contains up to 5 mononuclear leukocytes
(white blood cells) per microliter. Increased numbers may indicate infection. Specific
lab values may vary from medical facility to medical facility.
 Sugar (glucose). A low glucose level in spinal fluid may indicate infection or another
condition.
 Microorganisms. The presence of bacteria, viruses, fungi or other microorganisms can
indicate infection.
 Cancer cells. The presence of abnormal cells in spinal fluid — such as tumor or
immature blood cells — can indicate certain types of cancer.
Lab results are combined with information obtained during the test, such as spinal fluid
pressure, to help establish a possible diagnosis
POST SURGICAL CARE

5. The patient is restricted to bed rest in a flat position on the stomach for 4 to 12 hours as
prescribed by the physician to provent the CSF from leaking from the puncture site.
The nurses encourage the patient to increase fluid intake for 24 to 48 hours facilitates fluid
intake to facilitate CSF production.
Reduction in CSF may cause a severe ,throbbing headache enalgesics can be given for
headache if it occurs.
 Plan to rest. Don't participate in strenuous activities the day of your procedure. You
may return to work if your job doesn't require you to be physically active. Discuss your
activities with your doctor if you have questions.
 Take a pain medication. A nonprescription pain-relieving medication that contains
acetaminophen can help reduce headache or back pain.
COMPLICATION
Though lumbar puncture is generally recognized as safe, it does carry some risks. These
include:headache,brain herniation,breeding, and infection,CSF leakage, Hematoma formation.
 Post-lumbar puncture headache. Up to 25 percent of people who have undergone a
lumbar puncture develop a headache afterward due to a leak of fluid into nearby tissues.
The headache typically starts several hours up to two days after the procedure and may
be accompanied by nausea, vomiting and dizziness. The headaches are usually present
when sitting or standing and resolve after lying down. Post-lumbar puncture headaches
can last from a few hours to a week or more.
 Back discomfort or pain. You may feel pain or tenderness in your lower back after the
procedure. The pain might radiate down the back of your legs.
 Bleeding. Bleeding may occur near the puncture site or, rarely, into the epidural space.
 Brainstem herniation. Increased pressure within the skull (intracranial), due to a brain
tumor or other space-occupying lesion, can lead to compression of the brainstem after a
sample of cerebrospinal fluid is removed.

6. A computerized tomography (CT) scan or MRI prior to a lumbar puncture can be
obtained to determine if there is evidence of a space-occupying lesion that results in
increased intracranial pressure. This complication is uncommon.