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APARNA A 
1st year MSc Nursing 
College Of Nursing 
Kottayam
LUMBAR PUNCTURE or SPINAL TAP is carried 
out by inserting a needle into Lumbar 
subarachnoid space to withdraw C S F
 To obtain C S F for analysis & diagnosis of: 
◦ Meningitis 
◦ Meningoencephalitis 
◦ Subarachnoid hemorrhage 
◦ Malignancy – diagnosis and treatment 
◦ Pseudotumor Cerebri 
◦ Other neurologic syndromes 
 To drain C S F & reduce intracranial space 
 To instill medications
 Increased intracranial pressure 
◦ Head CT before study if focal neurologic findings 
present to rule out impending cerebral mass 
herniation 
• If platelet count is less than 40,000 and 
Prothrombin time is less than 50% of control
 Hydrocephalus- Enlarged ventricle size & in 
suspected normal pressure Hydrocephalus 
 Coma- If C T is negative and I C P increased 
 Meningitis- Exclude mass lesion & confirm 
diagnosis
 Use smallest possible gauge [20/22] 
 Prefer atraumatic rather than cutting needle 
•1.5 in for < 1 yr 
•2.5 in for 1 year to 
middle childhood 
•3.5 in for older 
children and 
adolescents 
•Larger for large 
adolescents
 Needle is inserted into subarachnoid space 
through intervertebral space
 Spinal cord ends at L1-L2, so sites for puncture are 
located at L3-L4 or L4-L5 
 Restrain patient in lateral decubitus position 
◦ Maximally flex spine without compromising 
airway 
◦ Keep alignment of feet, knees and hips 
◦ Position head to left if right handed or vice versa
•Sterile CSF tray 
with 
•Spinal needle 
•Anesthetic such as: 
Topical- Zylocaine cream or 
Lidocaine 1% with 25 gauge needle 
and syringe 
•Povidone-iodine solution & sponge 
•Drapes, gauze, and bandages 
•Manometer, stopcock, tubing and 
specimen bottles
 Obtain a written consent for the procedure 
 Explain the procedure to the patient 
 Determine whether patient have any doubts 
or misconceptions 
 Reassure the patient 
 Instruct patient to void after procedure
•Position the patient at one 
side of edge of bed 
•Place a small pillow under 
patient’s head & another 
between the legs 
•Assist the patient to maintain 
position 
•Encourage patient to relax & to 
breath normally 
•Describe the procedure step by
•The physician cleanses the site 
with antiseptic solution and drapes 
the site 
•Local anesthetic is injected to 
numb the site and a spinal needle 
is inserted to subarachnoid space 
with stylet with bevel up to keep
 A specimen of C S F is collected usually in 
three test tubes 
 Needle is withdrawn & a small dressing is 
applied at puncture site 
 Sent specimen to lab 
immediately
 Instruct patient to lie on prone for 2 to 3 
hours 
 Monitor patient for any complications 
 Encourage increased fluid intake
 Headache 
Back pain [Occasionally with short-lived ] 
◦ Disc herniation if needle advanced too far 
 Bleeding or fluid leak around spinal cord 
 Infection, pain, hematoma 
 Subarachnoid epidermal cyst 
 Ocular muscle palsy (1%) 
 Nerve Trauma 
 Brainstem herniation
 Throbbing bifrontal & occipital headache 
 Dull and deep in character 
 Severe on sitting or standing 
IT CAN BE AVOIDED BY: 
Using small gauge needle 
Keep patient prone after procedure for 2 hours, 
then side-lying for 2-3 hours, then supine or 
prone for 6 or more hours
 Bed rest 
 Analgesics 
 Hydration 
 Epidural blood patch
 Clear and colourless 
 Secreted by choroid plexus 
 Exists in subarachnoid space 
 It is about 150-200ml acts as shock absorber 
transports nutrients
1. If C S F is blood tinged 3 samples has to be 
collected 
2. Uniformly stained SA H 
1 2 3 
3. CSF clears in 3rd bottle-Traumatic trap 
1 2 3
 Usually obtained for cell count, culture, 
glucose and protein testing 
 R B C and Differential W B C 
 Bacteriological –Gram stain and culture 
 Biochemical-Protein[0.15-0.45g/l] 
- glucose [0.45-0.70g/l]
 SAH : Spectrophotometry 
 Malignant Tumor: Cytology 
 Tuberculosis: Polymerase chain reaction, 
Jensen Culture 
 Non-bacterial Infection: Virology, fungal & 
parasitic studies 
 Demyelinating Disease: Oligoclonal bands 
 Neurosyphilis: V D R L test 
 Cryptococcus: culture, antigen detection 
 H I V : culture, antigen detection & antiviral 
antibodies
Lumbar punture

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Lumbar punture

  • 1. APARNA A 1st year MSc Nursing College Of Nursing Kottayam
  • 2. LUMBAR PUNCTURE or SPINAL TAP is carried out by inserting a needle into Lumbar subarachnoid space to withdraw C S F
  • 3.  To obtain C S F for analysis & diagnosis of: ◦ Meningitis ◦ Meningoencephalitis ◦ Subarachnoid hemorrhage ◦ Malignancy – diagnosis and treatment ◦ Pseudotumor Cerebri ◦ Other neurologic syndromes  To drain C S F & reduce intracranial space  To instill medications
  • 4.  Increased intracranial pressure ◦ Head CT before study if focal neurologic findings present to rule out impending cerebral mass herniation • If platelet count is less than 40,000 and Prothrombin time is less than 50% of control
  • 5.  Hydrocephalus- Enlarged ventricle size & in suspected normal pressure Hydrocephalus  Coma- If C T is negative and I C P increased  Meningitis- Exclude mass lesion & confirm diagnosis
  • 6.  Use smallest possible gauge [20/22]  Prefer atraumatic rather than cutting needle •1.5 in for < 1 yr •2.5 in for 1 year to middle childhood •3.5 in for older children and adolescents •Larger for large adolescents
  • 7.  Needle is inserted into subarachnoid space through intervertebral space
  • 8.  Spinal cord ends at L1-L2, so sites for puncture are located at L3-L4 or L4-L5  Restrain patient in lateral decubitus position ◦ Maximally flex spine without compromising airway ◦ Keep alignment of feet, knees and hips ◦ Position head to left if right handed or vice versa
  • 9. •Sterile CSF tray with •Spinal needle •Anesthetic such as: Topical- Zylocaine cream or Lidocaine 1% with 25 gauge needle and syringe •Povidone-iodine solution & sponge •Drapes, gauze, and bandages •Manometer, stopcock, tubing and specimen bottles
  • 10.  Obtain a written consent for the procedure  Explain the procedure to the patient  Determine whether patient have any doubts or misconceptions  Reassure the patient  Instruct patient to void after procedure
  • 11. •Position the patient at one side of edge of bed •Place a small pillow under patient’s head & another between the legs •Assist the patient to maintain position •Encourage patient to relax & to breath normally •Describe the procedure step by
  • 12. •The physician cleanses the site with antiseptic solution and drapes the site •Local anesthetic is injected to numb the site and a spinal needle is inserted to subarachnoid space with stylet with bevel up to keep
  • 13.  A specimen of C S F is collected usually in three test tubes  Needle is withdrawn & a small dressing is applied at puncture site  Sent specimen to lab immediately
  • 14.  Instruct patient to lie on prone for 2 to 3 hours  Monitor patient for any complications  Encourage increased fluid intake
  • 15.  Headache Back pain [Occasionally with short-lived ] ◦ Disc herniation if needle advanced too far  Bleeding or fluid leak around spinal cord  Infection, pain, hematoma  Subarachnoid epidermal cyst  Ocular muscle palsy (1%)  Nerve Trauma  Brainstem herniation
  • 16.  Throbbing bifrontal & occipital headache  Dull and deep in character  Severe on sitting or standing IT CAN BE AVOIDED BY: Using small gauge needle Keep patient prone after procedure for 2 hours, then side-lying for 2-3 hours, then supine or prone for 6 or more hours
  • 17.  Bed rest  Analgesics  Hydration  Epidural blood patch
  • 18.  Clear and colourless  Secreted by choroid plexus  Exists in subarachnoid space  It is about 150-200ml acts as shock absorber transports nutrients
  • 19. 1. If C S F is blood tinged 3 samples has to be collected 2. Uniformly stained SA H 1 2 3 3. CSF clears in 3rd bottle-Traumatic trap 1 2 3
  • 20.  Usually obtained for cell count, culture, glucose and protein testing  R B C and Differential W B C  Bacteriological –Gram stain and culture  Biochemical-Protein[0.15-0.45g/l] - glucose [0.45-0.70g/l]
  • 21.  SAH : Spectrophotometry  Malignant Tumor: Cytology  Tuberculosis: Polymerase chain reaction, Jensen Culture  Non-bacterial Infection: Virology, fungal & parasitic studies  Demyelinating Disease: Oligoclonal bands  Neurosyphilis: V D R L test  Cryptococcus: culture, antigen detection  H I V : culture, antigen detection & antiviral antibodies