LUMBAR PUNCTURE

LUMBAR PUNCTURE

Lumbar puncture is a procedure during which a small amount cerebrospinal fluid (CSF) is withdrawn from the spinal canal and then analysed to determine its constituents.

INDICATION

This procedure is used to detect the presence of certain disease (multiple sclerosis, syphilis, meningitis) infection and malignancies. A lumbar puncture may also be used to reduce CSF pressure or administer medication or chemotherapy directly to spinal fluid.

PRE-PROCEDURE 

The risk versus benefits of a lumbar puncture should be discussed with the client prior to undertaking the procedure.

• A lumbar puncture may be associated with rare but serious complication, especially when performed in the presence of increased ICP
• Lumbar puncture for client with bleeding disorders or taking anticoagulants may result in bleeding that compresses the spinal cord.

nursing intervention

• Ensure that the client jewellery has been removed and that the client is wearing only a hospital gown.
• Instruct the client to void prior to the procedure.
• Client should be positioned to stretch the spinal canal. This may be done by having the client assume a "cannonball" position while on one side or by having client stretch over an overbed table if sitting is preferred.

INTRA PROCEDURE

• The area of the needle insertion is cleaned, and a local anaesthesia is injected.
• This is not a painful procedure; there should be little need for pain or relaxing medication other than local anaesthesia. 
• Then needle is inserted and the CSF is withdrawn, after which the needle removed.

POST-PROCEDURE

• CSF sent to the pathology department for analysis.
• Monitor the puncture site. The client should remain to lay for several hours to ensure that the site clots and to decrease the risk of a post-lumbar puncture headache, caused by CSF leakage.
• Once stable, advise the client that the normal activities may be resumed.

COMPLICATIONS

• CSF leakage
• If clotting does not occur to seal the dural puncture site, CSF may leak, resulting in a headache and increasing the potential for infection.

  

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