Lumbar Puncture, Assisting
Lumbar puncture involves the insertion of a sterile needle into the subarachnoid space of the spinal canal, usually between the third and fourth lumbar vertebrae. This procedure is used to determine the presence of blood in cerebrospinal fluid (CSF), to obtain CSF specimens for laboratory analysis, and to inject dyes for contrast in radiologic studies. The pressure of CSF, which flows freely between the brain and the spinal column, may be measured during the procedure. It’s also used to administer drugs or anesthetics.
Performed by a doctor with a nurse assisting, lumbar puncture requires sterile technique and careful patient positioning. This procedure is contraindicated in patients with increased intracranial pressure (ICP) with mass effect, with a lumbar deformity, with a platelet count of less than 50,000/mm3, who have an International Normalized Ratio greater than 1.5, who are receiving anticoagulants,1 or who have an infection at the puncture site.
Equipment
Overbed table ▪ one or two pairs of sterile gloves for the doctor ▪ sterile gloves for the nurse ▪ face masks1 ▪ antiseptic solution ▪ sterile gauze pads ▪ antiseptic pads ▪ sterile fenestrated drape ▪ 3-mL syringe for local anesthetic ▪ 25G ¾″ sterile needle for injecting anesthetic ▪ local anesthetic (usually 1% lidocaine) ▪ 22G 3½″ spinal needle with stylet2 ▪ three-way stopcock ▪ manometer ▪ small adhesive bandage ▪ three sterile collection tubes with stoppers ▪ laboratory request forms ▪ labels ▪ light source such as a gooseneck lamp ▪ sterile marker ▪ sterile labels ▪ laboratory transport bag ▪ Optional: patient-care reminder.
Disposable lumbar puncture trays contain most of the needed sterile equipment.
Implementation
Perform a preprocedure verification to make sure that all relevant documentation, related information, and equipment are available and correctly identified to the patient’s identifiers.3
Gather the equipment and take it to the patient’s bedside.
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.7
Explain the procedure to the patient to ease his anxiety and ensure his cooperation.
Make sure an informed consent form has been obtained and documented in the patient’s medication record.8,9
Inform the patient that he may experience headache after lumbar puncture, but reassure him that his cooperation during the procedure minimizes such an effect.
Check the patient’s history for hypersensitivity to local anesthetic.
Immediately before the procedure, provide privacy and instruct the patient to void.
Open the equipment tray on an overbed table, being careful not to contaminate the sterile field when you open the wrapper. Label all medications, medication containers, and other solutions on and off the sterile field.10
Provide adequate lighting at the puncture site, and adjust the height of the patient’s bed to allow the doctor to perform the procedure comfortably.
Position the patient and reemphasize the importance of remaining as still as possible to minimize discomfort and trauma. (See Positioning for lumbar puncture.)
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