LUMBAR PUNCTURE

Definition: Lumbar puncture is the introduction of a hollow needle into the subarachnoid space of the spinal cannal and usually
in the lumbar region.
Purposes:1 To withdraw cerebro spinal fluid to relieve pressure.
2 To secure specimens of C. S. F. for diagnostic purpose.
3 To inject sera or drug in the treatment of the diseases.
4 To inject spinal anaesthetic.
5 To introduce an opaque liquid or air or oxygen before taking an X-ray for diagnosis of cord and brain lesions.
6 To test the pressure of the spinal fluid under different conditions.
When opaque substances are injected and X-ray pictures are taken, it is known as MYELOGRAM. When air or oxygen
is injected the procedure is called Pneumoencephalogr am.
Preparation of the patient:The lumbar region should be washed well with soap and water (shaved if necessary) wiped and dried. Then apply some
antiseptics as Tr: iodine or spirit, and covered with sterile towel and fix with binder. L. P. is done between the 2nd and 3 rd or
4th and 5th intervertebral space because the spinal cord ends at the level of the 1 st lumbar vertebra.
Position of the Patient:Put the patient in right or left lateral position near the edge of the bed (according to the convenience of the physician).
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Have his back arched so that his head is almost touching his knees, instruct the patient to draw his knees up towards the
chest. In any way, tru back should be arched to widen the intervertebral space. Nurse should help him to lie in the proper
position.
The treatment can be done in sitting position also. A table or chair must be provided for the patient to lean on, so as to
arch his back and the nurse should support by standing in front of the patient.
Requisites:A Screen to provide privacy.
Unsterile tray containing:
1) Small mackintosh and towel to protect the bed,
2) Bottles of Tr: iodine and spirit, or any antiseptic to clean the skin, Tr. Benzoin
3) Bottles of local anaesthetic as novacaine 1 percent.
4) Bottle of drug or serum in case of introduction into the spinal column.
5) Kidney tray.
6) Sterile normal saline in a bottle.
Sterile tray containing:1) Sterile towels 2 (one to wipe hands of the Doctor and one fene started towel for the patient)
2) Small bowls 2 (one for local anaesthetic, and one for cotton swabs)
3) 2cc syringe and needles for giving local anaesthetic (if necessary)
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4) Spinal needles 2 (of different sizes) with fitting stiletto

5) Sponege holding forceps.
6) Manometer (in case pressure is to be noted)
7) Three way adaptor -1
8) Sterile dressings to apply over puncture
9) sterile bottles with cork (to obtain specimens) or test tubes.
10)
Sterile gloves and mask.
11)
One syringe and needle in case drug has to be introduced.

Procedure:Explain the procedure to the patient.

Provide privacy.
Assemble the equipment to the bedside.
Protect the bed with mackintosh and towel.
Put the patient in position as explained before, at the edge of the bed. Fold the clothing down to the hip so that the
back is free from clothes. Cover chest with a small blanket or towel. Explain that there will be certain amount of pain which
is unavoidable. He should keep himself without shaking.
If the patient is in a sagging bed a board is placed under the bed to get fir mness and to get the correct spinal
curvature. Doctor gets ready (washing his hands thoroughly and dressed in sterile gloves and mask). Provide a stool to sit if
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necessary. The skin area at the lumbar region is cleaned and painted with Tr: iodine using forceps, and the forceps is
discarded in the kidney tray.
After the skin is prepared, cover the part with a' sterile towel or a Fenestrated sheet (a sheet with a hole in the middle).
Local anaesthetic is given sometimes with 2 cc syringe and needle by injecting novocaine 1 percent.
Then the lumbar region is punctured with the spinal needle usually done at the lumbar intervertebral space.
If specimen is to be collected it should be taken as soon as begins to drop-from the needle, without touching the
needle. If pressure is to be noted, Manometer is attached to the needle, to note the pressure. When a serum or any drug is
to-be injected, the same quantity of spinal fluid is withdrawn and an equal quantity of drug

is injected. Usually 20 to 50

cc of serum is injected.
After

the removal of fluid or

introduction of therapuetic drug

doctors use their gloved hand to close the needle) and

the wound. Throughout

the procedure

respiration should be watched.

it is

then

the

the needle

needle is closed with the stilette (sometimes

is withdrawn and sterile dressing applied over

the nurse's duty to watch the patient carefully. The

Anycomplaint that the patient made such

colour,

pulse and

as headache or nausea, should be reported

immediately to the surgeon. After

raised

particularly if a serum

the treatment, the patient usually is put in the recumbent

position

or drug is introduced or otherwise ordered by the physician. The

with the foot

patient should stay

in bed at least 24 hours after a lumbar puncture.

Any specimen taken should be labelled properly and send for examination.
Record the treatment, date, time, amount, character of spinal fluid withdrawn, its colour (cloudy or bloody) whether it
is drawn with pressure and discomfort shown by the patient. Any drug or serum injected into the spinal column, its quan tity and nature, whether the specimen has been sent to the laboratory for examination and by whom it was done.
N.B. If the patient is child or an infant it should be restrained to prevent it from moving its limbs at the time of the
procedure. Sometimes the patient's B. P is to be checked at frequent intervals.
Normal C. S. F is clear, colourless. Usually 1 or 2 drops per second flows from the needle. But under high pressure it
may spurt out. Pressure at the jugular veins causes increase in pressure. Sometimes the first fluid flows from the needle
may the blood stained. In inflammation of the meninges, the C. S. F. may show an increase in pressure. Normal pressure of
spinal fluid is 100 to 130 mm of water and sp: gravity is 1006 (Encyclopedia).
In acute infections, the fluid may be cloudy or yellow in colour or turbid because of the presence of pus. Blood usually

dark in colour may indicate injury to the spinal cord above the site of puncture.
Cisternal Puncture
Definition: Is the introduction of a needle into the cistern magna (enlargement of the subarachnoid space just below
the cerebellum) and it is similar in nature of lumbar puncture except for the area of injection.
Purposes:To diagnose spinal block.
1) To introduce serum in inflammation.
2) To introduce drugs directly into the meningeal space.
3) To inject air or opaque drug before making an encephalogram to discover the location of brain lesions.
Position of Patient: Same as for lumbar puncture, but the head must rest on a small sand pillow or sand bag. Patient is told to tilt his
head forward, to draw his legs up and fold his arms over the chest.
Cisternal puncture is same as lumbar puncture but the only difference is that the physician inserts the needle
between the first and second cervical vertebrae. The preparation of patient and equipments
puncture.

are all same as lumbar

BIBLIOGRAPHY

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Kluwer (India) pvt. Ltd New Delhi, Page No: 333-336
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