Lumbar puncture

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Using a needle to sample cerebrospinal fluid and on occasions to administer substances into the CSF space, e.g. intrathecal chemotherapy or spinal anaesthesia.

LogoWarningBox4.pngAseptic means aseptic. You are entering the central nervous system. Meningitis is bad.



  1. Explain procedure to patient and get consent.
  2. Position patient
    • Curled up with head and neck flexed.
    • Some find the sitting up position easier than lying down.
  3. Identify and mark space between L3/4 or L4/L5, below the end of spinal cord. See Tuffier's line
    • You can use ultrasound to locate if trained and available. NNT to prevent one failed LP is 16[1]
  4. Wash hands and don gloves
  5. Clean skin thoroughly
  6. Infiltrate with local
  7. Set up manometer while waiting for local to work
  8. Insert needle
    • "Aiming for umbilicus"
    • It's further than you think
    • Feel the give going through the dura
    • Remove stillette
  9. Connect manometer and measure opening pressure
  10. Collect samples - inspect for "gin clear appearance"
    • Biochemistry - protein, glucose, xanthochromia
    • Microbiology - MC+S
    • Cytology
  11. Withdraw needle - ?replace stillette
  12. Dressing
  13. Label samples
  14. Write up procedure in notes
  15. Smug grin.