Web Resources for Lumbar puncture
Relevant Clinical Literature
Wikipedia on Lumbar puncture (Less technical, ? quality control)
UpToDate® on Lumbar puncture (Technical, SUBSCRIPTION)
- Spinal needle
- Skin preparation (iodine-based or chlorhexidine cleaning agent)
- Local anaesthetic
- Universal containers
- Sterile gloves
- Explain procedure to patient and get consent.
- Position patient
- Curled up with head and neck flexed.
- Some find the sitting up position easier than lying down.
- 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
- Wash hands and don gloves
- Clean skin thoroughly
- Infiltrate with local
- Set up manometer while waiting for local to work
- Insert needle
- "Aiming for umbilicus"
- It's further than you think
- Feel the give going through the dura
- Remove stillette
- Connect manometer and measure opening pressure
- Collect samples - inspect for "gin clear appearance"
- Biochemistry - protein, glucose, xanthochromia
- Microbiology - MC+S
- Withdraw needle - ?replace stillette
- Label samples
- Write up procedure in notes
- Smug grin.