NURSING PROCEDURE 77-1

Assisting With a Lumbar Puncture

SUPPLIES AND EQUIPMENT

Sterile gloves Dressing materials Local anesthetic solution (sterile), usually lidocaine (Xylocaine) Bath blanket

Prepackaged sterile, disposable LP kit Clean gloves Antiseptic solution Specimen labels External light source (may be needed)
E S NP Comments

RECOMMENDED TECHNIQUE

1. Be sure the procedure has been thoroughly explained to the client, and make sure that the client has signed the consent form. (Nursing students do not witness these permits.) 2. Wash hands. Assemble all equipment at the bedside. Know that the physician will wear sterile gloves and may use goggles or a face shield, per Standard Precautions. 3. Identify the client, and ask the client to empty the bladder. 4. Assess the clients vital signs before the procedure. 5. Assist the client with removing any clothing and putting on a gown that opens in the back. Drape the client with a bath blanket or sheet. 6. Place equipment within the physicians reach. Open packs and make sure extra sterile gloves are available. Provide extra lighting as necessary. 7. Position the client on his or her side with the lower part of the back at the edge of the bed. Help the client to draw his or her knees up toward the chin and to bend his or her head forward. 8. When the procedure begins, move the drape to uncover the clients back. Tell the person to lie very still, holding the client in place if necessary. 9. Talk to the client during the procedure, offering reassurance as necessary. 10. Assist as requested, such as with removing caps on bottles, labeling specimens, or assisting with dressing placement over the LP site.

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Copyright 2003 by Lippincott Williams & Wilkins. Procedure Checklists to Accompany Rosdahl & Kowalskis Textbook of Basic Nursing, eighth edition, by Marjorie L. Roark.

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77-1

Assisting With a Lumbar Puncture

RECOMMENDED TECHNIQUE (Continued)

NP

Comments

11. Note the beginning CSF pressure, as measured by the physician. Also assess the color and clarity of the CSF, which should be pale and clear. 12. Monitor the client for any difficulties or problems. 13. After the procedure, return the client to a comfortable position in bed. Keep the clients head flat (supine) for at least 6 hours or as otherwise ordered. 14. Remove and dispose of equipment as indicated. Finish labeling specimens and completing request forms; send specimens to the laboratory immediately in an approved biohazard bag. Properly dispose of gloves. 15. Wash hands. 16. Document the procedure carefully. 17. Assess the clients vital signs and neurologic signs, comparing them to baseline data. Assess the clients level of consciousness (LOC). Report any unusual findings to the physician. 18. Encourage fluids, unless contraindicated, and record intake and output. Encourage the client to lie flat. 19. Monitor the insertion site for leakage of CSF, hematoma formation, or edema. 20. Assess severity of headache if it occurs. Report severe headache unrelieved by mild analgesics or that lasts more than 24 hours.

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KEY: E = Excels

S = Satisfactory Fail

NP = Needs Practice

Pass

Students Signature:

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Date: _________________ Date: _________________

Instructors Signature: ___________________________________________________________

Copyright 2003 by Lippincott Williams & Wilkins. Procedure Checklists to Accompany Rosdahl & Kowalskis Textbook of Basic Nursing, eighth edition, by Marjorie L. Roark.