Preparation for a lumbar puncture overview

A lumbar puncture is an invasive procedure that involves the insertion of a needle into the subarachnoid space. This will be performed to assist with diagnosis or to permit treatment. For diagnostic purposes, a sample of the cerebrospinal fluid (CSF) is taken if meningitis, encephalitis or other neurological conditions are suspected. It may also be used to remove excess CSF and measure the pressure of the CSF. Contrast media may also be inserted into the subarachnoid space during radiological investigation. Medication may be instilled when a lumbar puncture is required for therapeutic purposes.

An invasive and high-risk procedure, this must be performed aseptically and by an experienced doctor. Two nurses are required to assist with this procedure.

Written consent should be obtained.

Role of the nurse

The role of the nurse in a lumbar puncture is to provide a safe environment in which the procedure may be performed. Supporting the child and family is essential at all stages. The nurse who assumes the responsibility of positioning the child during the lumbar puncture must understand the safe holding technique and be fully conversant with the potential contraindications and complications of this procedure. The nurse who is assisting the doctor needs to understand the principles of aseptic technique and adhere to this when assisting with a lumbar puncture.

Equipment

• Lumbar puncture pack
  
• Lumbar puncture needles correct size
  
• Sterile cleaning agent
  
• Sterile containers × 3
  
• Glucose sample container
  
• Specimen request form
  
• Sterile towels
  
• Sterile gloves
  
• Local anaesthetic
  
• Sterile adhesive dressing

Local policy must be adhered to in regard to skin cleansing agent and collection containers used.

If the child is sedated or seriously ill, then monitoring equipment must be in situ.

Procedure

• Prepare the equipment
  
• Nurse 1: Position the child, right or left side on the edge of the examination bed. Knees are drawn up towards chest and neck is flexed. Craniospinalaxis is parallel to the bed. This position will need to be maintained for the duration of the procedure.
  
• It is useful to have play specialist available to talk to child and provide distraction during procedure.
  
• Nurse 2: Remove the local anaesthetic cream and assist the doctor in cleaning the skin and administering the local anaesthetic.
  
• Doctor will insert the needle between L3 and L4 or L4 and L5.
  
• Discard the first few drops of CSF.
  
• Collect 1–2 ml (10 drops maximum) in each sterile container. Label 1, 2, 3 in order of collection.
  
• Apply sterile dressing to puncture site once needle has been removed.
  
• Safely dispose of all equipment.
  
• Observe puncture site for CSF leakage and ask the child if they have any headache.
  
• Encourage the child to lie flat if possible, adhere to local guidelines.
  
• Record vital signs and neurological observations if indicated.
  
• Report all abnormalities in vital signs, behaviour or CSF leakage immediately.
  
• Administer analgesia as prescribed post procedure.
  
• Maintain nursing records as required.
  
• Keep family and child informed of results and implications of these.

Side-effects of a lumbar puncture

• Headache
  
• CSF leak from puncture site
  
• Back pain at site
  
• Bleeding from puncture site
  
• Herniation of cerebrum
  
• Infection.