Lumbar Puncture

Write a short note on the Preparation for and care during lumbar puncture.

Definition
A procedue where a long needle is inserted into the lumbar subarachnoid space to withdraw CSF

Indications
CSF examination in cases like meningitis
To measure and reduce CSF pessure
To determine the presence or absence of blood in the CSF
To detect spinal subarachnoid block
To administer antibiotics intrathecally


The preprocedure
consent
explain
reassurance 
Examination of the fundus of the eye to detect papilloedema due to increased intracranial pressure - to guard against cerebral herniation.
Instruct to void before the procedure

The procedure
Lateral decubitus position
Sitting up position 
At the edge of bed
In the position the thighs and legs are flexed as much as possible
A pillow to head
A pillow between legs
Hold the patient to maintain position
Instruct ot breathe normally and relax
Describe as the precedure is done
Clean the site
Local Anesthetic infiltrated into the site
Spinal needle inserte into one of the spaces between the 3, 4, 5 intervertebral spaces
The needle is advanced until there is a giving way sensation and fluid starts to drip out
The fluid is collected in a small sterile bottled and labelled with full details of the patient
The fluid is sent immediately to the lab.
Normal Values
Pressure in a lateral recumbent position : 70 to 200 mm of H20
Queckenstedt's Test : manometry : compressing the jugular veins and record pressure every 10 seconds. Rapid increase is normal. On releasing the pressure quickly returns to normal: slow rise and slow fall  partial block
No pressure  complete block
This test is not performed if intracranial lesion  is suspected.

Problems
Post-lumbar headache - use a small gauge needle so that leakage is minimized. 
Increase fluid intake
Lie prone for 3 hours.
Avoid upright position for 12 hours. 
analgesics, hydration. epidural blood patch in the epidural space may be used if persistant

Herniation of the intracranial contents
Spinal epidural abscess
Spinal epidural hematoma
Meningitis
Temporary  voiding problems
Slight elevation of temperature
Back ache
Spasms
Stiffness of the neck


















































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