To measure cerebrospinal fluid (CSF) pressure

To aid in the diagnosis of viral or bacterial meningitis, subarachnoid or intracranial hemorrhage, tumors and brain abscesses, and neurosyphilis and chronic central nervous system infections

Make sure that the consent form is signed by the child’s parents or legal guardians.

Note and report all allergies.

Inform the child and his parents that there are no food or fluid restrictions.

Instruct the child to empty his bladder and bowels before the procedure.

Explain the importance of remaining still throughout the procedure.

Inform the child and his parents that the test takes at least 15 minutes.

Explain that headache is the most common adverse effect.

Confirm the child’s identity by checking two patient identifiers.

Position the child on his side at the edge of the bed with his knees drawn up to his abdomen and his chin tucked against his chest (the fetal position), or position the child sitting while leaning over a bedside table. (See Lumbar puncture positioning, page 384.)

If the child is in a supine position, provide pillows to support the spine on a horizontal plane.

Gently hold even a cooperative child during the procedure to prevent injury from unexpected or involuntary movement.

The skin site is prepared and draped.

A local anesthetic is injected.

Monitor the child’s vital signs and neurologic status throughout the procedure.

The spinal needle is inserted in the midline between the spinous processes of the vertebrae (usually between L3 and L4 or L4 and L5).

The stylet is removed from the needle; CSF will drip out of the needle if properly positioned.

A stopcock and manometer are attached to the needle to measure the initial (opening) CSF pressure.